California Newborn Screening Program
Specimen Collection Procedure
The Specimen Collection Form or Test request Form (TRF) for Newborn Screening is provided to every perinatal licensed health facility by the Genetic Disease Screening Program (GDSP) at a cost of $1.00 per form. GDSP also bills the facility a program fee of $129.25 for each completed specimen received. The facilities in turn can charge $1.00 plus the program fee per newborn for the total screening process. (This includes the initial test and any necessary repeat or recall testing until the newborn screen is resolved.) In addition, each facility may charge up to $6.00 for specimen collection and handling. Medi-Cal covers the complete screening process, including the specimen collection fee. Private insurance generally covers both the newborn screening and the specimen collection fee.
The TRF is the only acceptable form for newborn screening tests. The TRF consists of a filter paper card for specimen collection and a page containing fields for recording critical information about the baby. It also contains information about screening on pages that are to be detached and given to the mother.
The completed TRF is sent to the designated State-contracted newborn screening and prenatal (NAPS) laboratories for data entry and testing of the dried blood spots (DBS). All information, including the test results, are transmitted via computer to a central site in Richmond, CA, from which follow-up is monitored and result mailers are sent. The coordination of follow-up of non-negative screens, i.e., inadequate specimens, specimens collected too early and initial positive tests, is conducted at NBS Area Service Centers.
DRIED BLOOD SPOT (DBS) COLLECTION
Instructions for collecting adequate dried blood spots appear on the Test Request Form
1. CHECK THE EXPIRATION DATE ON THE FORM. The expiration information is in the lower right hand corner of the TRF:
Example: LOT XXXXXX/XXXXX2015-02 (the expiration year is 2015, and the expiration month is 02) - do not use as of the FIRST DAY of the expiration month.
A specimen collected on an expired form will be deemed inadequate and the screen will need to be redone, thus delaying test results.
2. AVOID TOUCHING THE SPECIMEN COLLECTING AREA at any time with gloved or ungloved hands. Oil, lotion, or powder from hands or gloves can prevent the blood from spreading evenly and thoroughly. Use un-powdered gloves.
3. BLOOD IS TO BE COLLECTED FROM THE HEEL. Do NOT collect blood from intravenous/intra-arterial lines, antecubital space or dorsal hand veins unless a heel stick is not possible.
4. DO NOT USE CAPILLARY TUBES for collecting the blood to spot on the card. It can damage the filter paper, resulting in an inadequate specimen.
5. STERILIZE the skin with alcohol. WIPE DRY with a sterile gauze pad.
6. PUNCTURE the heel with a disposable lancet deep enough to reach the skin's primary blood supply, yet shallow enough to prevent heel or bone injury.
7. ALLOW A LARGE DROP OF BLOOD TO ACCUMULATE; wipe away with a sterile gauze.
8. ALLOW A SECOND DROP OF BLOOD TO ACCUMULATE, then APPLY THE DROP TO ONE SIDE OF A CIRCLE ON THE NBS COLLECTION CARD.
9. ALLOW CIRCLES TO FILL BY NATURAL FLOW until the circle is completely filled when applying a large accumulated drop of blood to the specimen collection card. Repeat for each circle.
The circles should be filled completely when viewed from both sides. Fill all the circles.
AVOID REPEATED APPLICATIONS of specimen collection card to the heel to fill any one circle.
KEEP AWAY FROM HEAT, LAMPS, DIRECT SUNLIGHT, AND HUMIDITY.
10. AIR-DRY BLOOD SPOTS THOROUGHLY AT ROOM TEMPERATURE (for at least three hours) on a flat surface.
11. Specimens should not be placed in plastic bags or packaging.
12. SEND SPECIMENS TO THE ASSIGNED NAPS LAB WITHIN 24 HOURS OF COLLECTION. Specimens are transported either by a lab courier or by Golden State Overnight (GSO). A transport log (provided by the NAPS Lab), listing the babies whose specimens are in the envelope, must accompany each shipment.
- Reminder: A detached white copy will be viewed as inadequate. If the white copy gets detached, write the baby's name and date of birth on the lines provided on the filter paper, and staple the filter paper to the bottom of the white copy. Collecting the specimen properly and keepng the form intact are crucial the keeping the specimen adequate. An inadequate specimen will need to be redone, and may put the baby in life-threatening danger.
- On weekends and holidays, when specimens are not picked up, they should be stored in a controlled environment away from heat and humidity until they can be transported. They should not be refrigerated.
- Check with the mail room personnel as to how they assure timely specimen pickup. It is important to avoid exposure to heat and humidity, so if curbside mail collection boxes are used, care needs to be taken as to when these NBS specimen packages are deposited, particularly during the summer months.
Specimen Collection Card (also known as TRF) Handout (PDF)
Specimen Collection Card (also known as TRF) Poster (PDF)
Instructions for Shipping NBS Specimens via GSO (PDF)
Instructions for Shipping NBS Specimens via GSO for Midwives and Doctors (PDF)