+-----------------------+----------------------------------------------+
| ![](media/image1.jp   | Module 14                                    |
| eg){width="1.90625in" |                                              |
| height="1             | **Blood Collection**                         |
| .8729166666666666in"} |                                              |
|                       | **and Handling --**                          |
|                       |                                              |
|                       | **Dried Blood Spot (DBS)**                   |
+-----------------------+----------------------------------------------+

+----------------+-----------------------------------------------------+
|                |                                                     |
+----------------+-----------------------------------------------------+
| **Purpose**    | To provide you with the skills to collect and       |
|                | handle dried blood spots (DBS) for EQA purposes.    |
+----------------+-----------------------------------------------------+
| **P            | Module 6: Safety at HIV Rapid Testing Site          |
| re-requisite** |                                                     |
|                | Module 8: Blood Collection -- Fingerprick           |
| **Modules**    |                                                     |
|                | Module 13: EQA                                      |
+----------------+-----------------------------------------------------+
| **Learning     | At the end of this module, you will be able to:     |
| Objectives**   |                                                     |
|                | -   Collect dried blood spots (DBS)                 |
|                |                                                     |
|                | -   Package and store DBS in a way to maintain      |
|                |     specimen integrity                              |
|                |                                                     |
|                | -   Maintain DBS records                            |
|                |                                                     |
|                | -   Distinguish between valid and invalid DBS       |
+----------------+-----------------------------------------------------+
| **Content      | > Required supplies                                 |
| Outline**      | >                                                   |
|                | > How to collect and dry DBS                        |
|                | >                                                   |
|                | > How to package and store DBS                      |
|                | >                                                   |
|                | > Valid and invalid DBS                             |
|                | >                                                   |
|                | > Hands-on practice                                 |
+----------------+-----------------------------------------------------+
| **Handout**    | Example Specimen Transfer Log for Re-Testing        |
+----------------+-----------------------------------------------------+
| ![](media      |                                                     |
| /image2.wmf){w |                                                     |
| idth="0.491666 |                                                     |
| 66666666664in" |                                                     |
| height="0.     |                                                     |
| 44166666666666 |                                                     |
| 665in"}**Notes |                                                     |
| on             |                                                     |
| C              |                                                     |
| ustomization** |                                                     |
+----------------+-----------------------------------------------------+

+---------------+----------------------+---+---+---+---+------------------------+
| **What Is a   | Dried Blood Spots    |   |   |   |   |                        |
| Dried Blood   | (DBS) are whole      |   |   |   |   |                        |
| Spot (DBS)?** | blood collected on   |   |   |   |   |                        |
|               | filter paper and     |   |   |   |   |                        |
|               | dried. They are made |   |   |   |   |                        |
|               | directly from the    |   |   |   |   |                        |
|               | client's whole       |   |   |   |   |                        |
|               | blood.               |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | DBS are used for     |   |   |   |   |                        |
|               | re-testing at a      |   |   |   |   |                        |
|               | reference            |   |   |   |   |                        |
|               | laboratory, which    |   |   |   |   |                        |
|               | may be part of your  |   |   |   |   |                        |
|               | country's External   |   |   |   |   |                        |
|               | Quality Assessment   |   |   |   |   |                        |
|               | plan. Testing site   |   |   |   |   |                        |
|               | results are compared |   |   |   |   |                        |
|               | to reference         |   |   |   |   |                        |
|               | laboratory results.  |   |   |   |   |                        |
|               | DBS samples are      |   |   |   |   |                        |
|               | useful for           |   |   |   |   |                        |
|               | re-testing as they   |   |   |   |   |                        |
|               | are easy to collect, |   |   |   |   |                        |
|               | store, and           |   |   |   |   |                        |
|               | transport.           |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **EQA         | Remember...Two types |   |   |   |   |                        |
| Re-testing**  | of specimens may be  |   |   |   |   |                        |
|               | collected at the     |   |   |   |   |                        |
|               | site for referral to |   |   |   |   |                        |
|               | a reference lab for  |   |   |   |   |                        |
|               | re-testing:          |   |   |   |   |                        |
|               | serum/plasma or      |   |   |   |   |                        |
|               | dried blood spots    |   |   |   |   |                        |
|               | (DBS).               |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **What Are    | Your EQA             |   |   |   |   |                        |
| Your          | responsibilities     |   |   |   |   |                        |
| Respon        | include:             |   |   |   |   |                        |
| sibilities?** |                      |   |   |   |   |                        |
|               | -   Collecting valid |   |   |   |   |                        |
|               |     specimens        |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Labeling and     |   |   |   |   |                        |
|               |     store            |   |   |   |   |                        |
|               |     appropriately    |   |   |   |   |                        |
|               |     until            |   |   |   |   |                        |
|               |     transported for  |   |   |   |   |                        |
|               |     re-testing       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Ensuring records |   |   |   |   |                        |
|               |     are properly     |   |   |   |   |                        |
|               |     maintained       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Avoiding         |   |   |   |   |                        |
|               |     transcription    |   |   |   |   |                        |
|               |     errors           |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | A test result is     |   |   |   |   |                        |
|               | only as good as the  |   |   |   |   |                        |
|               | specimen collected.  |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **EQA         | An example EQA       |   |   |   |   |                        |
| Specimen      | specimen transfer    |   |   |   |   |                        |
| Transfer      | log is provided for  |   |   |   |   |                        |
| Log**         | your reference at    |   |   |   |   |                        |
|               | the end of this      |   |   |   |   |                        |
|               | module.              |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Data recorded on     |   |   |   |   |                        |
|               | transfer logs must   |   |   |   |   |                        |
|               | be accurate. Care    |   |   |   |   |                        |
|               | should be taken in   |   |   |   |   |                        |
|               | transferring         |   |   |   |   |                        |
|               | information from     |   |   |   |   |                        |
|               | test records to EQA  |   |   |   |   |                        |
|               | transfer log. Errors |   |   |   |   |                        |
|               | that are typically   |   |   |   |   |                        |
|               | made include:        |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Specimen ID on   |   |   |   |   |                        |
|               |     transfer log     |   |   |   |   |                        |
|               |     sheet doesn't    |   |   |   |   |                        |
|               |     match specimen   |   |   |   |   |                        |
|               |     ID filter paper  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Final result at  |   |   |   |   |                        |
|               |     testing site     |   |   |   |   |                        |
|               |     incorrectly      |   |   |   |   |                        |
|               |     transcribed from |   |   |   |   |                        |
|               |     test records     |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Required    | When collecting DBS, |   |   | > |   |                        |
| Supplies for  | you need the         |   |   |   |   |                        |
| DBS**         | following items:     |   |   | ! |   |                        |
|               |                      |   |   | [ |   |                        |
|               | -   Blood collection |   |   | ] |   |                        |
|               |     card (filter     |   |   | ( |   |                        |
|               |     paper)           |   |   | m |   |                        |
|               |                      |   |   | e |   |                        |
|               | -   Glycine weighing |   |   | d |   |                        |
|               |     paper            |   |   | i |   |                        |
|               |                      |   |   | a |   |                        |
|               | -   Sealable plastic |   |   | / |   |                        |
|               |     bags             |   |   | i |   |                        |
|               |                      |   |   | m |   |                        |
|               | -   Humidity cards   |   |   | a |   |                        |
|               |                      |   |   | g |   |                        |
|               | -   Desiccant packs  |   |   | e |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | . |   |                        |
|               |                      |   |   | p |   |                        |
|               |                      |   |   | n |   |                        |
|               |                      |   |   | g |   |                        |
|               |                      |   |   | ) |   |                        |
|               |                      |   |   | { |   |                        |
|               |                      |   |   | w |   |                        |
|               |                      |   |   | i |   |                        |
|               |                      |   |   | d |   |                        |
|               |                      |   |   | t |   |                        |
|               |                      |   |   | h |   |                        |
|               |                      |   |   | = |   |                        |
|               |                      |   |   | " |   |                        |
|               |                      |   |   | 2 |   |                        |
|               |                      |   |   | . |   |                        |
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|               |                      |   |   | 5 |   |                        |
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|               |                      |   |   | " |   |                        |
|               |                      |   |   | > |   |                        |
|               |                      |   |   |   |   |                        |
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|               |                      |   |   | t |   |                        |
|               |                      |   |   | = |   |                        |
|               |                      |   |   | " |   |                        |
|               |                      |   |   | 1 |   |                        |
|               |                      |   |   | . |   |                        |
|               |                      |   |   | 9 |   |                        |
|               |                      |   |   | 2 |   |                        |
|               |                      |   |   | 0 |   |                        |
|               |                      |   |   | 8 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 3 |   |                        |
|               |                      |   |   | 4 |   |                        |
|               |                      |   |   | i |   |                        |
|               |                      |   |   | n |   |                        |
|               |                      |   |   | " |   |                        |
|               |                      |   |   | } |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Other supplies       |   |   |   |   |                        |
|               | include safety       |   |   |   |   |                        |
|               | supplies such as     |   |   |   |   |                        |
|               | discard bins and     |   |   |   |   |                        |
|               | supplies for         |   |   |   |   |                        |
|               | performing a         |   |   |   |   |                        |
|               | fingerprick. While   |   |   |   |   |                        |
|               | the collection card  |   |   |   |   |                        |
|               | may include 5        |   |   |   |   |                        |
|               | circles, only one    |   |   |   |   |                        |
|               | patient/client's     |   |   |   |   |                        |
|               | blood may be         |   |   |   |   |                        |
|               | collected on one     |   |   |   |   |                        |
|               | card.                |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **How to      | Always use Universal |   |   |   |   | ![](med                |
| Collect DBS** | Safety Precautions.  |   |   |   |   | ia/image4.jpeg){width= |
|               | This includes:       |   |   |   |   | "1.9979166666666666in" |
|               |                      |   |   |   |   | height="               |
|               | -   Treat all blood  |   |   |   |   | 1.4930555555555556in"} |
|               |     samples as       |   |   |   |   |                        |
|               |     though they are  |   |   |   |   | ***It is critical that |
|               |     infectious       |   |   |   |   | entire circle be       |
|               |                      |   |   |   |   | uniformly              |
|               | ```{=html}           |   |   |   |   | saturated***.          |
|               | <!-- -->             |   |   |   |   |                        |
|               | ```                  |   |   |   |   |                        |
|               | -   Wash hands       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | ```{=html}           |   |   |   |   |                        |
|               | <!-- -->             |   |   |   |   |                        |
|               | ```                  |   |   |   |   |                        |
|               | -   Wear gloves and  |   |   |   |   |                        |
|               |     apron/lab coat   |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Take precaution  |   |   |   |   |                        |
|               |     to avoid needle  |   |   |   |   |                        |
|               |     injury           |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               |     -   Dispose of   |   |   |   |   |                        |
|               |         contaminated |   |   |   |   |                        |
|               |         sharps and   |   |   |   |   |                        |
|               |         waste        |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               |        appropriately |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Clearly label each   |   |   |   |   |                        |
|               | card with            |   |   |   |   |                        |
|               | appropriate          |   |   |   |   |                        |
|               | identification       |   |   |   |   |                        |
|               | number -- It is      |   |   |   |   |                        |
|               | unacceptable to      |   |   |   |   |                        |
|               | submit a blood card  |   |   |   |   |                        |
|               | for testing that has |   |   |   |   |                        |
|               | not been properly    |   |   |   |   |                        |
|               | labeled.             |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Follow the           |   |   |   |   |                        |
|               | fingerprick          |   |   |   |   |                        |
|               | procedure and the    |   |   |   |   |                        |
|               | additional steps     |   |   |   |   |                        |
|               | below:               |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Apply gentle     |   |   |   |   |                        |
|               |     pressure to the  |   |   |   |   |                        |
|               |     finger and allow |   |   |   |   |                        |
|               |     a large drop of  |   |   |   |   |                        |
|               |     free flowing     |   |   |   |   |                        |
|               |     blood to collect |   |   |   |   |                        |
|               |     at the puncture  |   |   |   |   |                        |
|               |     site.            |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Working quickly, |   |   |   |   |                        |
|               |     hold the filter  |   |   |   |   |                        |
|               |     paper by the     |   |   |   |   |                        |
|               |     edges and touch  |   |   |   |   |                        |
|               |     the filter paper |   |   |   |   |                        |
|               |     gently against   |   |   |   |   |                        |
|               |     the large drop   |   |   |   |   |                        |
|               |     of blood and in  |   |   |   |   |                        |
|               |     one step allow a |   |   |   |   |                        |
|               |     sufficient       |   |   |   |   |                        |
|               |     quantity of      |   |   |   |   |                        |
|               |     blood to soak    |   |   |   |   |                        |
|               |     through and      |   |   |   |   |                        |
|               |     completely fill  |   |   |   |   |                        |
|               |     or saturate a    |   |   |   |   |                        |
|               |     circle. A        |   |   |   |   |                        |
|               |     completed        |   |   |   |   |                        |
|               |     saturated spot   |   |   |   |   |                        |
|               |     will contain 100 |   |   |   |   |                        |
|               |     µl of blood.     |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Repeat, until    |   |   |   |   |                        |
|               |     you have         |   |   |   |   |                        |
|               |     collected enough |   |   |   |   |                        |
|               |     blood to fill at |   |   |   |   |                        |
|               |     least 3 circles  |   |   |   |   |                        |
|               |     on the blood     |   |   |   |   |                        |
|               |     collection card. |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Completing       |   |   |   |   |                        |
|               |     filling the      |   |   |   |   |                        |
|               |     circle is        |   |   |   |   |                        |
|               |     important        |   |   |   |   |                        |
|               |     because the      |   |   |   |   |                        |
|               |     laboratory will  |   |   |   |   |                        |
|               |     need to use a    |   |   |   |   |                        |
|               |     hole puncher to  |   |   |   |   |                        |
|               |     punch a section  |   |   |   |   |                        |
|               |     of the circle of |   |   |   |   |                        |
|               |     blood for        |   |   |   |   |                        |
|               |     testing          |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   If collecting    |   |   |   |   |                        |
|               |     spots using a    |   |   |   |   |                        |
|               |     pipette, collect |   |   |   |   |                        |
|               |     100 µl of blood  |   |   |   |   |                        |
|               |     and gently apply |   |   |   |   |                        |
|               |     to filter paper. |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Additional tips:     |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   DO NOT press the |   |   |   |   |                        |
|               |     filter paper     |   |   |   |   |                        |
|               |     against the      |   |   |   |   |                        |
|               |     puncture site.   |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Apply blood to   |   |   |   |   |                        |
|               |     only one side of |   |   |   |   |                        |
|               |     the filter       |   |   |   |   |                        |
|               |     paper.           |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Do not layer     |   |   |   |   |                        |
|               |     successive drops |   |   |   |   |                        |
|               |     of blood or      |   |   |   |   |                        |
|               |     apply blood more |   |   |   |   |                        |
|               |     than once in the |   |   |   |   |                        |
|               |     same collection  |   |   |   |   |                        |
|               |     circle.          |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | ```{=html}           |   |   |   |   |                        |
|               | <!-- -->             |   |   |   |   |                        |
|               | ```                  |   |   |   |   |                        |
|               | -   Do not "milk"    |   |   |   |   |                        |
|               |     the finger as    |   |   |   |   |                        |
|               |     excessive        |   |   |   |   |                        |
|               |     milking or       |   |   |   |   |                        |
|               |     squeezing the    |   |   |   |   |                        |
|               |     puncture site    |   |   |   |   |                        |
|               |     might cause      |   |   |   |   |                        |
|               |     hemolysis of the |   |   |   |   |                        |
|               |     specimen or      |   |   |   |   |                        |
|               |     result in        |   |   |   |   |                        |
|               |     collection of    |   |   |   |   |                        |
|               |     tissue fluids    |   |   |   |   |                        |
|               |     with the         |   |   |   |   |                        |
|               |     specimen, which  |   |   |   |   |                        |
|               |     might adversely  |   |   |   |   |                        |
|               |     affect the test  |   |   |   |   |                        |
|               |     result. (NOTE:   |   |   |   |   |                        |
|               |     "*hemo*-" means  |   |   |   |   |                        |
|               |     red cells,       |   |   |   |   |                        |
|               |     "-*lysis*" means |   |   |   |   |                        |
|               |     destruction,     |   |   |   |   |                        |
|               |     "*hemolysis*"    |   |   |   |   |                        |
|               |     means            |   |   |   |   |                        |
|               |     destruction of   |   |   |   |   |                        |
|               |     red cells.)      |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | NOTE: Two complete   |   |   |   |   |                        |
|               | circles are better   |   |   |   |   |                        |
|               | than five incomplete |   |   |   |   |                        |
|               | ones! While the      |   |   |   |   |                        |
|               | collection card may  |   |   |   |   |                        |
|               | include 5 circles,   |   |   |   |   |                        |
|               | only one             |   |   |   |   |                        |
|               | patient/client's     |   |   |   |   |                        |
|               | blood may be         |   |   |   |   |                        |
|               | collected on one     |   |   |   |   |                        |
|               | card.                |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **How to Dry  | Important tips for   |   |   |   |   |                        |
| DBS**         | drying DBS:          |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Avoid touching   |   |   |   |   |                        |
|               |     or smearing the  |   |   |   |   |                        |
|               |     blood spots      |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Allow the        |   |   |   |   |                        |
|               |     specimen to      |   |   |   |   |                        |
|               |     fully air dry    |   |   |   |   |                        |
|               |     horizontally (at |   |   |   |   |                        |
|               |     least 3 hours)   |   |   |   |   |                        |
|               |     at room          |   |   |   |   |                        |
|               |     temperature      |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Keep away from   |   |   |   |   |                        |
|               |     direct           |   |   |   |   |                        |
|               |     sunlight - Care  |   |   |   |   |                        |
|               |     should be taken  |   |   |   |   |                        |
|               |     to avoid         |   |   |   |   |                        |
|               |     exposing DBS to  |   |   |   |   |                        |
|               |     environmental    |   |   |   |   |                        |
|               |     conditions that  |   |   |   |   |                        |
|               |     may compromise   |   |   |   |   |                        |
|               |     the integrity of |   |   |   |   |                        |
|               |     the specimen.    |   |   |   |   |                        |
|               |     DBS should not   |   |   |   |   |                        |
|               |     be dried near an |   |   |   |   |                        |
|               |     open window as   |   |   |   |   |                        |
|               |     sunlight, dust   |   |   |   |   |                        |
|               |     and in some      |   |   |   |   |                        |
|               |     cases flying     |   |   |   |   |                        |
|               |     insects may come |   |   |   |   |                        |
|               |     in contact with  |   |   |   |   |                        |
|               |     the DBS during   |   |   |   |   |                        |
|               |     the drying       |   |   |   |   |                        |
|               |     procedure.       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Do not heat,     |   |   |   |   |                        |
|               |     stack or allow   |   |   |   |   |                        |
|               |     DBS to touch     |   |   |   |   |                        |
|               |     other surfaces   |   |   |   |   |                        |
|               |     during the       |   |   |   |   |                        |
|               |     drying process   |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Dry         | There are several    |   |   |   |   |                        |
| Completely    | ways in which you    |   |   |   |   |                        |
| Before        | can effectively dry  |   |   |   |   |                        |
| Packaging**   | DBS                  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | ![](media/i          |   |   |   |   |                        |
|               | mage5.jpeg){width="2 |   |   |   |   |                        |
|               | .0181102362204726in" |   |   |   |   |                        |
|               | height="1.5681102362 |   |   |   |   |                        |
|               | 204724in"}![](media/ |   |   |   |   |                        |
|               | image6.jpeg){width=" |   |   |   |   |                        |
|               | 2.132677165354331in" |   |   |   |   |                        |
|               | height="1            |   |   |   |   |                        |
|               | .561023622047244in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | The image on the     |   |   |   |   |                        |
|               | left is one that was |   |   |   |   |                        |
|               | taken in India. DBS  |   |   |   |   |                        |
|               | are dried            |   |   |   |   |                        |
|               | horizontally between |   |   |   |   |                        |
|               | bamboo.              |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | The image on the     |   |   |   |   |                        |
|               | right can be         |   |   |   |   |                        |
|               | obtained from        |   |   |   |   |                        |
|               | Schleicher & Schuell |   |   |   |   |                        |
|               | Bioscience, Inc.     |   |   |   |   |                        |
|               | (Manufacturer of DBS |   |   |   |   |                        |
|               | collection cards)    |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | DBS change from      |   |   |   |   |                        |
|               | bright red to dark   |   |   |   |   |                        |
|               | red as they dry.     |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **How to      | Follow these steps:  |   |   |   |   |                        |
| Package DBS   |                      |   |   |   |   |                        |
| for storage:  | 1.  Appropriately    |   |   |   |   |                        |
| An overview** |     stack DBS        |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 2.  Insert into      |   |   |   |   |                        |
|               |     sealable plastic |   |   |   |   |                        |
|               |     bag              |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 3.  Add desiccant    |   |   |   |   |                        |
|               |     packets          |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 4.  Add humidity     |   |   |   |   |                        |
|               |     cards            |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 5.  Label contents   |   |   |   |   |                        |
|               |     of bag and seal. |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Step 1 -    | Place weighing or    |   |   |   |   |                        |
| Stack DBS**   | glycine paper        |   |   |   |   |                        |
|               | between DBS cards    |   |   |   |   |                        |
|               | before transport to  |   |   |   |   |                        |
|               | prevent              |   |   |   |   |                        |
|               | cross-contamination. |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | ![](media/           |   |   |   | ! |                        |
|               | image7.jpeg){width=" |   |   |   | [ |                        |
|               | 2.209722222222222in" |   |   |   | ] |                        |
|               | height="1.           |   |   |   | ( |                        |
|               | 7180555555555554in"} |   |   |   | m |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | d |                        |
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|               |                      |   |   |   | a |                        |
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|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 0 |                        |
|               |                      |   |   |   | 9 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | h |                        |
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|               |                      |   |   |   | h |                        |
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|               |                      |   |   |   | = |                        |
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|               |                      |   |   |   | 1 |                        |
|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 1 |                        |
|               |                      |   |   |   | 8 |                        |
|               |                      |   |   |   | 0 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 4 |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | } |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Place filter paper   |   |   |   | F |                        |
|               | between sheets of    |   |   |   | o |                        |
|               | weighing paper       |   |   |   | l |                        |
|               |                      |   |   |   | d |                        |
|               |                      |   |   |   | w |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | h |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | d |                        |
|               |                      |   |   |   | s |                        |
|               |                      |   |   |   | o |                        |
|               |                      |   |   |   | f |                        |
|               |                      |   |   |   | w |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | h |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | p |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | p |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | r |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Step 2 -    | You can typically    |   | ! |   |   |                        |
| Insert Into   | place up to 15 DBS   |   | [ |   |   |                        |
| Sealable      | cards in each        |   | ] |   |   |                        |
| Plastic Bag** | plastic bag. The bag |   | ( |   |   |                        |
|               | should be just the   |   | m |   |   |                        |
|               | right size to hold   |   | e |   |   |                        |
|               | the cards. Avoid     |   | d |   |   |                        |
|               | using bags that are  |   | i |   |   |                        |
|               | too big as the cards |   | a |   |   |                        |
|               | will shuffle inside  |   | / |   |   |                        |
|               | the bag.             |   | i |   |   |                        |
|               |                      |   | m |   |   |                        |
|               |                      |   | a |   |   |                        |
|               |                      |   | g |   |   |                        |
|               |                      |   | e |   |   |                        |
|               |                      |   | 9 |   |   |                        |
|               |                      |   | . |   |   |                        |
|               |                      |   | j |   |   |                        |
|               |                      |   | p |   |   |                        |
|               |                      |   | e |   |   |                        |
|               |                      |   | g |   |   |                        |
|               |                      |   | ) |   |   |                        |
|               |                      |   | { |   |   |                        |
|               |                      |   | w |   |   |                        |
|               |                      |   | i |   |   |                        |
|               |                      |   | d |   |   |                        |
|               |                      |   | t |   |   |                        |
|               |                      |   | h |   |   |                        |
|               |                      |   | = |   |   |                        |
|               |                      |   | " |   |   |                        |
|               |                      |   | 2 |   |   |                        |
|               |                      |   | . |   |   |                        |
|               |                      |   | 3 |   |   |                        |
|               |                      |   | i |   |   |                        |
|               |                      |   | n |   |   |                        |
|               |                      |   | " |   |   |                        |
|               |                      |   | h |   |   |                        |
|               |                      |   | e |   |   |                        |
|               |                      |   | i |   |   |                        |
|               |                      |   | g |   |   |                        |
|               |                      |   | h |   |   |                        |
|               |                      |   | t |   |   |                        |
|               |                      |   | = |   |   |                        |
|               |                      |   | " |   |   |                        |
|               |                      |   | 1 |   |   |                        |
|               |                      |   | . |   |   |                        |
|               |                      |   | 7 |   |   |                        |
|               |                      |   | 8 |   |   |                        |
|               |                      |   | 8 |   |   |                        |
|               |                      |   | 1 |   |   |                        |
|               |                      |   | 9 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | 4 |   |   |                        |
|               |                      |   | i |   |   |                        |
|               |                      |   | n |   |   |                        |
|               |                      |   | " |   |   |                        |
|               |                      |   | } |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Sandwich bags will   |   |   |   |   |                        |
|               | not work as many of  |   |   |   |   |                        |
|               | these are of the     |   |   |   |   |                        |
|               | type where you fold  |   |   |   |   |                        |
|               | the top. The bag     |   |   |   |   |                        |
|               | should be a sealable |   |   |   |   |                        |
|               | heavy duty plastic   |   |   |   |   |                        |
|               | bag, one that will   |   |   |   |   |                        |
|               | prevent moisture     |   |   |   |   |                        |
|               | from entering.       |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Step 3 -    | ![](media/im         |   |   |   |   |                        |
| Add Desiccant | age10.jpeg){width="2 |   |   |   |   |                        |
| Packets**     | .1598425196850393in" |   |   |   |   |                        |
|               | he                   |   |   |   |   |                        |
|               | ight="1.679133858267 |   |   |   |   |                        |
|               | 7164in"}![](media/im |   |   |   |   |                        |
|               | age11.jpeg){width="2 |   |   |   |   |                        |
|               | .1598425196850393in" |   |   |   |   |                        |
|               | height="1.           |   |   |   |   |                        |
|               | 6791338582677164in"} |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | Desiccant packets    |   |   |   |   |                        |
|               | serve as a drying    |   |   |   |   |                        |
|               | agent. At least 5    |   |   |   |   |                        |
|               | desiccant packs      |   |   |   |   |                        |
|               | should be placed in  |   |   |   |   |                        |
|               | each bag. Some sites |   |   |   |   |                        |
|               | may need more or     |   |   |   |   |                        |
|               | fewer packets in     |   |   |   |   |                        |
|               | each bag depending   |   |   |   |   |                        |
|               | on environmental and |   |   |   |   |                        |
|               | storage conditions.  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | Desiccant packets    |   |   |   |   |                        |
|               | vary in size. The    |   |   |   |   |                        |
|               | ones seen here are   |   |   |   |   |                        |
|               | the smaller ones.    |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Step 4 -    | Often humidity cards |   |   |   | ! |                        |
| Add Humidity  | must be recharged    |   |   |   | [ |                        |
| Cards and     | before use. If the   |   |   |   | ] |                        |
| Seal Bag**    | humidity card is     |   |   |   | ( |                        |
|               | pink at the 30%      |   |   |   | m |                        |
|               | level, you must:     |   |   |   | e |                        |
|               |                      |   |   |   | d |                        |
|               | -   Recharge card    |   |   |   | i |                        |
|               |     and desiccant    |   |   |   | a |                        |
|               |     pack by heating  |   |   |   | / |                        |
|               |     at 50-60^○^C for |   |   |   | i |                        |
|               |     3-4 hours in a   |   |   |   | m |                        |
|               |     drying oven.     |   |   |   | a |                        |
|               |                      |   |   |   | g |                        |
|               | -   Cool 10 minutes. |   |   |   | e |                        |
|               |                      |   |   |   | 1 |                        |
|               | -   IMMEDIATELY      |   |   |   | 2 |                        |
|               |     RETURN card and  |   |   |   | . |                        |
|               |     desiccant pack   |   |   |   | j |                        |
|               |     to sealable      |   |   |   | p |                        |
|               |     plastic bag.     |   |   |   | e |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | ) |                        |
|               |                      |   |   |   | { |                        |
|               |                      |   |   |   | w |                        |
|               |                      |   |   |   | i |                        |
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|               |                      |   |   |   | = |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 1 |                        |
|               |                      |   |   |   | 6 |                        |
|               |                      |   |   |   | 5 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 8 |                        |
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|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 6 |                        |
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|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | s |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | c |                        |
|               |                      |   |   |   | c |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | t |                        |
|               |                      |   |   |   | p |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | c |                        |
|               |                      |   |   |   | k |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | t |                        |
|               |                      |   |   |   | s |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | s |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | l |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | b |                        |
|               |                      |   |   |   | l |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | b |                        |
|               |                      |   |   |   | a |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | o |                        |
|               |                      |   |   |   | r |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | v |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | l |                        |
|               |                      |   |   |   | o |                        |
|               |                      |   |   |   | p |                        |
|               |                      |   |   |   | e |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Step 5 -    | A permanent marker   | ! |   |   |   |                        |
| Label Outside | should be used to    | [ |   |   |   |                        |
| of Plastic    | clearly label the    | ] |   |   |   |                        |
| Bag with      | contents on the bag. | ( |   |   |   |                        |
| Contents**    |                      | m |   |   |   |                        |
|               |                      | e |   |   |   |                        |
|               |                      | d |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | a |   |   |   |                        |
|               |                      | / |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | m |   |   |   |                        |
|               |                      | a |   |   |   |                        |
|               |                      | g |   |   |   |                        |
|               |                      | e |   |   |   |                        |
|               |                      | 1 |   |   |   |                        |
|               |                      | 3 |   |   |   |                        |
|               |                      | . |   |   |   |                        |
|               |                      | j |   |   |   |                        |
|               |                      | p |   |   |   |                        |
|               |                      | e |   |   |   |                        |
|               |                      | g |   |   |   |                        |
|               |                      | ) |   |   |   |                        |
|               |                      | { |   |   |   |                        |
|               |                      | w |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | d |   |   |   |                        |
|               |                      | t |   |   |   |                        |
|               |                      | h |   |   |   |                        |
|               |                      | = |   |   |   |                        |
|               |                      | " |   |   |   |                        |
|               |                      | 2 |   |   |   |                        |
|               |                      | . |   |   |   |                        |
|               |                      | 2 |   |   |   |                        |
|               |                      | 0 |   |   |   |                        |
|               |                      | 7 |   |   |   |                        |
|               |                      | 6 |   |   |   |                        |
|               |                      | 3 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 9 |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | n |   |   |   |                        |
|               |                      | " |   |   |   |                        |
|               |                      | h |   |   |   |                        |
|               |                      | e |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | g |   |   |   |                        |
|               |                      | h |   |   |   |                        |
|               |                      | t |   |   |   |                        |
|               |                      | = |   |   |   |                        |
|               |                      | " |   |   |   |                        |
|               |                      | 1 |   |   |   |                        |
|               |                      | . |   |   |   |                        |
|               |                      | 4 |   |   |   |                        |
|               |                      | 3 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 8 |   |   |   |                        |
|               |                      | 9 |   |   |   |                        |
|               |                      | i |   |   |   |                        |
|               |                      | n |   |   |   |                        |
|               |                      | " |   |   |   |                        |
|               |                      | } |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **How to      | Keep packaged DBS    |   |   |   |   |                        |
| Store DBS**   | (in sealable plastic |   |   |   |   |                        |
|               | bags) cool and dry   |   |   |   |   |                        |
|               | until transported to |   |   |   |   |                        |
|               | reference            |   |   |   |   |                        |
|               | laboratory. It is    |   |   |   |   |                        |
|               | also acceptable to   |   |   |   |   |                        |
|               | store DBS in a       |   |   |   |   |                        |
|               | Styrofoam box.       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | Avoid leaving it in  |   |   |   |   |                        |
|               | a vehicle, as sun    |   |   |   |   |                        |
|               | and heat will        |   |   |   |   |                        |
|               | deteriorate DBS      |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | Avoid placing spots  |   |   |   |   |                        |
|               | in an malfunctioning |   |   |   |   |                        |
|               | refrigerator where   |   |   |   |   |                        |
|               | water may drip on or |   |   |   |   |                        |
|               | soak the spots       |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **How to      | ![](media/i          |   |   |   |   |                        |
| Package DBS   | mage14.jpeg){width=" |   |   |   |   |                        |
| for           | 2.078472222222222in" |   |   |   |   |                        |
| Shipping**    | height="1.           |   |   |   |   |                        |
|               | 4201388888888888in"} |   |   |   |   |                        |
|               | ![](media/im         |   |   |   |   |                        |
|               | age15.jpeg){width="1 |   |   |   |   |                        |
|               | .9715277777777778in" |   |   |   |   |                        |
|               | height="1.38125in"}  |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | Follow these steps:  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 1.  Insert bundled   |   |   |   |   |                        |
|               |     DBS into         |   |   |   |   |                        |
|               |     rip-resistant    |   |   |   |   |                        |
|               |     envelope. The    |   |   |   |   |                        |
|               |     sealable plastic |   |   |   |   |                        |
|               |     bag has a label  |   |   |   |   |                        |
|               |     on the outside   |   |   |   |   |                        |
|               |     indicating       |   |   |   |   |                        |
|               |     bio-hazardous    |   |   |   |   |                        |
|               |     contents.        |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 2.  Include          |   |   |   |   |                        |
|               |     appropriate      |   |   |   |   |                        |
|               |     documentation    |   |   |   |   |                        |
|               |     (such as EQA     |   |   |   |   |                        |
|               |     Specimen         |   |   |   |   |                        |
|               |     Transfer Log)    |   |   |   |   |                        |
|               |     with the         |   |   |   |   |                        |
|               |     shipment         |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | 3.  Insert both into |   |   |   |   |                        |
|               |     brown envelop    |   |   |   |   |                        |
|               |     and seal for     |   |   |   |   |                        |
|               |     shipment.        |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Valid DBS   | This specimen is     |   |   |   |   | ![](media/image16      |
| Specimen**    | valid because:       |   |   |   |   | .jpeg){width="2.425in" |
|               |                      |   |   |   |   | height="1.58125in"}    |
|               | -   100 µl of blood  |   |   |   |   |                        |
|               |     has been         |   |   |   |   |                        |
|               |     collected in     |   |   |   |   |                        |
|               |     each circle      |   |   |   |   |                        |
|               |     completely       |   |   |   |   |                        |
|               |     saturating or    |   |   |   |   |                        |
|               |     filling the      |   |   |   |   |                        |
|               |     circle           |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   The filter paper |   |   |   |   |                        |
|               |     card has been    |   |   |   |   |                        |
|               |     labeled with     |   |   |   |   |                        |
|               |     appropriate      |   |   |   |   |                        |
|               |     identification.  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Blood is soaked  |   |   |   |   |                        |
|               |     through to the   |   |   |   |   |                        |
|               |     other side of    |   |   |   |   |                        |
|               |     the card.        |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Valid DBS   | On the card with     |   |   |   | ! |                        |
| Specimen**    | MB/KP/120, the blood |   |   |   | [ |                        |
|               | is spreading from    |   |   |   | ] |                        |
|               | one circle to        |   |   |   | ( |                        |
|               | another due to the   |   |   |   | m |                        |
|               | anemia (anemic blood |   |   |   | e |                        |
|               | is more fluid). This |   |   |   | d |                        |
|               | is still considered  |   |   |   | i |                        |
|               | a valid specimen.    |   |   |   | a |                        |
|               | Blood has completely |   |   |   | / |                        |
|               | filled the circle.   |   |   |   | i |                        |
|               | Notice that the      |   |   |   | m |                        |
|               | third and fifth      |   |   |   | a |                        |
|               | circles have been    |   |   |   | g |                        |
|               | punched (hence the   |   |   |   | e |                        |
|               | white area in the    |   |   |   | 1 |                        |
|               | middle).             |   |   |   | 7 |                        |
|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | j |                        |
|               |                      |   |   |   | p |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | ) |                        |
|               |                      |   |   |   | { |                        |
|               |                      |   |   |   | w |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | d |                        |
|               |                      |   |   |   | t |                        |
|               |                      |   |   |   | h |                        |
|               |                      |   |   |   | = |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 6 |                        |
|               |                      |   |   |   | 4 |                        |
|               |                      |   |   |   | 0 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 8 |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | h |                        |
|               |                      |   |   |   | e |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | g |                        |
|               |                      |   |   |   | h |                        |
|               |                      |   |   |   | t |                        |
|               |                      |   |   |   | = |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | 1 |                        |
|               |                      |   |   |   | . |                        |
|               |                      |   |   |   | 7 |                        |
|               |                      |   |   |   | 2 |                        |
|               |                      |   |   |   | 0 |                        |
|               |                      |   |   |   | 8 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 3 |                        |
|               |                      |   |   |   | 4 |                        |
|               |                      |   |   |   | i |                        |
|               |                      |   |   |   | n |                        |
|               |                      |   |   |   | " |                        |
|               |                      |   |   |   | } |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/i          |   |   |   |   |                        |
| Specimen**    | mage18.jpeg){width=" |   |   |   |   |                        |
|               | 3.140277777777778in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 7111111111111111in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because      |   |   |   |   |                        |
|               | quantity of blood is |   |   |   |   |                        |
|               | insufficient for     |   |   |   |   |                        |
|               | testing. This may    |   |   |   |   |                        |
|               | have been caused     |   |   |   |   |                        |
|               | by::                 |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Removing filter  |   |   |   |   |                        |
|               |     paper before     |   |   |   |   |                        |
|               |     blood has        |   |   |   |   |                        |
|               |     completely       |   |   |   |   |                        |
|               |     filled circle or |   |   |   |   |                        |
|               |     before blood has |   |   |   |   |                        |
|               |     soaked through   |   |   |   |   |                        |
|               |     to the other     |   |   |   |   |                        |
|               |     side             |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Applying blood   |   |   |   |   |                        |
|               |     to filter paper  |   |   |   |   |                        |
|               |     with a capillary |   |   |   |   |                        |
|               |     tube             |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Filter paper     |   |   |   |   |                        |
|               |     coming in        |   |   |   |   |                        |
|               |     contact with     |   |   |   |   |                        |
|               |     gloved or        |   |   |   |   |                        |
|               |     ungloved hands   |   |   |   |   |                        |
|               |     or substances    |   |   |   |   |                        |
|               |     such as hand     |   |   |   |   |                        |
|               |     lotion or        |   |   |   |   |                        |
|               |     powder, either   |   |   |   |   |                        |
|               |     before or after  |   |   |   |   |                        |
|               |     blood specimen   |   |   |   |   |                        |
|               |     collection       |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/image1     |   |   |   |   |                        |
| Specimen**    | 9.png){width="3.0in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 6701388888888888in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because it   |   |   |   |   |                        |
|               | appears scratched or |   |   |   |   |                        |
|               | abraded. This may    |   |   |   |   |                        |
|               | have been caused by  |   |   |   |   |                        |
|               | applying blood with  |   |   |   |   |                        |
|               | a capillary tube or  |   |   |   |   |                        |
|               | other device.        |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/i          |   |   |   |   |                        |
| Specimen**    | mage20.png){width="2 |   |   |   |   |                        |
|               | .8201388888888888in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 6902777777777778in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because the  |   |   |   |   |                        |
|               | specimen was not dry |   |   |   |   |                        |
|               | before mailing. DBS  |   |   |   |   |                        |
|               | must dry a minimum   |   |   |   |   |                        |
|               | of 4 hours before    |   |   |   |   |                        |
|               | packaging and        |   |   |   |   |                        |
|               | shipping.            |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/           |   |   |   |   |                        |
| Specimen**    | image21.png){width=" |   |   |   |   |                        |
|               | 3.029861111111111in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 6701388888888888in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because the  |   |   |   |   |                        |
|               | specimen appears     |   |   |   |   |                        |
|               | clotted or layered.  |   |   |   |   |                        |
|               | This may have been   |   |   |   |   |                        |
|               | caused by:           |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Touching the     |   |   |   |   |                        |
|               |     same circle on   |   |   |   |   |                        |
|               |     the filter paper |   |   |   |   |                        |
|               |     to blood drop    |   |   |   |   |                        |
|               |     several times    |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Filling circle   |   |   |   |   |                        |
|               |     on both sides of |   |   |   |   |                        |
|               |     filter paper     |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | The volume of        |   |   |   |   |                        |
|               | specimen will not be |   |   |   |   |                        |
|               | uniform between      |   |   |   |   |                        |
|               | spots resulting in   |   |   |   |   |                        |
|               | errors during the    |   |   |   |   |                        |
|               | testing process.     |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/image22    |   |   |   |   |                        |
| Specimen**    | .png){width="2.95in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 7076388888888889in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because the  |   |   |   |   |                        |
|               | specimen appears     |   |   |   |   |                        |
|               | hemolyzed,           |   |   |   |   |                        |
|               | discolored, or       |   |   |   |   |                        |
|               | contaminated. This   |   |   |   |   |                        |
|               | may have been caused |   |   |   |   |                        |
|               | by:                  |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Squeezing or     |   |   |   |   |                        |
|               |     "milking" of     |   |   |   |   |                        |
|               |     area surrounding |   |   |   |   |                        |
|               |     the puncture     |   |   |   |   |                        |
|               |     site             |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | ```{=html}           |   |   |   |   |                        |
|               | <!-- -->             |   |   |   |   |                        |
|               | ```                  |   |   |   |   |                        |
|               | -   Allowing filter  |   |   |   |   |                        |
|               |     paper to come in |   |   |   |   |                        |
|               |     contact with     |   |   |   |   |                        |
|               |     glove or         |   |   |   |   |                        |
|               |     ungloved hands   |   |   |   |   |                        |
|               |     or substances    |   |   |   |   |                        |
|               |     either before or |   |   |   |   |                        |
|               |     after blood      |   |   |   |   |                        |
|               |     collection       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Exposing blood   |   |   |   |   |                        |
|               |     spots to direct  |   |   |   |   |                        |
|               |     heat             |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/           |   |   |   |   |                        |
| Specimen**    | image23.png){width=" |   |   |   |   |                        |
|               | 3.020138888888889in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 6902777777777778in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because the  |   |   |   |   |                        |
|               | specimen exhibits    |   |   |   |   |                        |
|               | serum rings -- in    |   |   |   |   |                        |
|               | other words, serum   |   |   |   |   |                        |
|               | becomes separate     |   |   |   |   |                        |
|               | from cells. This may |   |   |   |   |                        |
|               | have been caused by: |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Not allowing     |   |   |   |   |                        |
|               |     alcohol to dry   |   |   |   |   |                        |
|               |     at puncture site |   |   |   |   |                        |
|               |     before making    |   |   |   |   |                        |
|               |     skin puncture    |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | ```{=html}           |   |   |   |   |                        |
|               | <!-- -->             |   |   |   |   |                        |
|               | ```                  |   |   |   |   |                        |
|               | -   Allowing filter  |   |   |   |   |                        |
|               |     paper to come in |   |   |   |   |                        |
|               |     contact with     |   |   |   |   |                        |
|               |     alcohol, hand    |   |   |   |   |                        |
|               |     lotion, etc.     |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Squeezing area   |   |   |   |   |                        |
|               |     surrounding      |   |   |   |   |                        |
|               |     puncture site    |   |   |   |   |                        |
|               |     excessively      |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Drying specimen  |   |   |   |   |                        |
|               |     improperly       |   |   |   |   |                        |
|               |                      |   |   |   |   |                        |
|               | -   Applying blood   |   |   |   |   |                        |
|               |     to filter paper  |   |   |   |   |                        |
|               |     with a capillary |   |   |   |   |                        |
|               |     tube             |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
| **Invalid DBS | ![](media/           |   |   |   |   |                        |
| Specimen**    | image24.png){width=" |   |   |   |   |                        |
|               | 2.890277777777778in" |   |   |   |   |                        |
|               | height="0.           |   |   |   |   |                        |
|               | 6798611111111111in"} |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+
|               | This specimen is     |   |   |   |   |                        |
|               | invalid because no   |   |   |   |   |                        |
|               | blood was applied to |   |   |   |   |                        |
|               | the filter paper.    |   |   |   |   |                        |
+---------------+----------------------+---+---+---+---+------------------------+

+-----------------+----------------------------------------------------+
| ![](me          | -   DBS are used for re-testing at a reference     |
| dia/image25.wmf |     laboratory, which may be part of your          |
| ){width="1.1701 |     country's External Quality Assessment plan     |
| 388888888888in" |                                                    |
| height="0.83194 | -   Care must be taken to collect, dry, store, and |
| 44444444445in"} |     ship dried blood spots used for re-testing.    |
|                 |                                                    |
| **Key message** |                                                    |
+-----------------+----------------------------------------------------+

+-----------------+----------------------------------------------------+
| ![](me          | Module Review                                      |
| dia/image26.wmf |                                                    |
| ){width="1.0in" |                                                    |
| height="0.96041 |                                                    |
| 66666666667in"} |                                                    |
+-----------------+----------------------------------------------------+
| Find out how    |                                                    |
| much you have   |                                                    |
| learned by      |                                                    |
| answering these |                                                    |
| questions.      |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| procedures for  |                                                    |
| collecting DBS. |                                                    |
|                 |                                                    |
| \_\_\_          |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| procedures for  |                                                    |
| drying DBS.     |                                                    |
| \_\_\_          |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| procedures for  |                                                    |
| packaging DBS   |                                                    |
| for storage.    |                                                    |
| \_\_\_          |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| procedures for  |                                                    |
| storing DBS.    |                                                    |
| \_\_\_\_\_\_    |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
|                 |                                                    |
| \_\_\_\_\_\_    |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
|                 |                                                    |
| \_\_\_\_\_\_    |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| ![](me          | Module Review                                      |
| dia/image26.wmf |                                                    |
| ){width="1.0in" |                                                    |
| height="0.96041 |                                                    |
| 66666666667in"} |                                                    |
+-----------------+----------------------------------------------------+
| Find out how    |                                                    |
| much you have   |                                                    |
| learned by      |                                                    |
| answering these |                                                    |
| questions.      |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| procedures for  |                                                    |
| packaging DBS   |                                                    |
| for shipping.   |                                                    |
| \_\_\_          |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| Describe the    |                                                    |
| criteria for    |                                                    |
| valid DBS       |                                                    |
| samples.        |                                                    |
| \_\_\_\_\       |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+
| -   What may    |                                                    |
|     have caused |                                                    |
|     a DBS       |                                                    |
|     sample to   |                                                    |
|     be invalid? |                                                    |
|                 |                                                    |
|     \_\_\_      |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
| \_\_\_\_\_\_\_\ |                                                    |
| _\_\_\_\_\_\_\_ |                                                    |
+-----------------+----------------------------------------------------+

**Example Specimen Transfer Log for Re-testing**

**\[Insert Name of Referring Testing Site,**

**Contact Name**

**Address and Phone Number\]**

**Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Referring Testing
Site
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

<table style="width:100%;">
<colgroup>
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
<col style="width: 10%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Specimen Tracking Number</strong></td>
<td><p><strong>Test Subject</strong></p>
<p><strong>ID*</strong></p></td>
<td><strong>Final Result (Testing Site)</strong></td>
<td><strong>Date Specimen Collected</strong></td>
<td><p><strong>Specimen Type</strong></p>
<p><strong>(DBS or Serum)</strong></p></td>
<td><strong>Collected by</strong></td>
<td><strong>Referral Lab Req<sup>†</sup> Completed ()</strong></td>
<td><strong>Date to referral lab</strong></td>
<td><p><strong>Date Conf</strong></p>
<p><strong>Result Received</strong></p></td>
<td><strong>Result of Re-test</strong></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
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</tr>
<tr class="odd">
<td></td>
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</tr>
<tr class="even">
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</tr>
<tr class="odd">
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<tr class="even">
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</tr>
<tr class="odd">
<td></td>
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</tr>
<tr class="even">
<td></td>
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<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
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<td></td>
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<td></td>
</tr>
<tr class="odd">
<td></td>
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<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

\*ID = Identification

^†^Lab Req = Laboratory Requisition