Processing, Storage, and Shipment of Specimens


This module describes activities occurring from the time the specimens reach the laboratory following collection to the point of testing, including specimen receipt, processing, storage, and shipment.

Learning Objectives
To receive, process, store, and transport specimens collected as part of a serosurvey

Topics Covered in this module
Technical and logistical demands of processing, storage, and shipment of specimens

Note: Refer to below modules for related information

Getting Started

  • There may be multiple levels of specimen processing – done immediately after receipt at the laboratory and done just prior to the point of specimen testing. These may either be done in two separate laboratories or all steps may occur at the same laboratory where testing occurs, with no intermediary local laboratory (see Figure 1).
Figure 1. Flow of specimens from reception to testing. Steps in orange are only relevant if there is an intermediary laboratory (e.g., health facility, local site) involved.

The goal of this module is to prepare the user for these demands prior to initiating a study and guide the user through the steps from receiving, processing, and storing the specimens at the local laboratory to shipment to the central laboratory.

  • Primary considerations:
    • The laboratory should have all the equipment and supplies in place before the start of the work
    • Laboratory staff should be hired and fully trained in required specimen-related procedures before the start of the study.
  • Standard operating procedures (SOPs) should be created to account for all steps required for managing specimens:

Preparing the Laboratory

The equipment and supplies needed for processing the specimens will differ based on specimen type and existing capacity and needs of the laboratory. Regardless of the specimen type, each laboratory should have a dedicated space where the site laboratory technician can store supplies and perform processing. There are key considerations for each laboratory (Box 1). Refer to Specimen Collection Module for more details on laboratory assessments.

Key considerations for specimen processing
  • Is there existing staff in place to support laboratory activities or will staff need to be hired for this purpose?
  • Is there available space in the laboratory for storing supplies and space for processing specimens?
  • What equipment is required? For example, -20° C freezer for short-term storage of venous specimens. If required, consider:
      • Is there adequate back-up generator power in case of outages?
      • Is there a temperature monitor on the freezer? Is there already a standard practice to monitor freezer temperature daily?
  • What is needed to complete documentation? Example: paper-based register or computer for data entry
  • For venous specimens: When can the specimens be processed relative to the time of collection? If unable to process same day, is there a 2-8° C refrigerator to store specimens overnight (after blood has clotted)?
  • For dried blood spots: If using intermediary laboratory, is there an area with minimal humidity (air-conditioned room) and light exposure? How to monitor temperature in the area where specimens are stored?
  • How often will specimens be shipped to the central laboratory (e.g., at completion of survey or during survey conduct)? Is there adequate space at the laboratory to store specimens prior to shipment?


Generally, the local laboratory will receive specimen collection and processing supplies from the central laboratory (in the situation with both a local and central laboratory). The site laboratory technician and site coordinator should perform an inventory of the supplies received and report any concerns to the central laboratory team. Some items may need to be purchased locally, where possible. If space allows, the field collection supplies should be organized in a way that allows the survey laboratory technician to easily gather supplies on the day of specimen collection; this storage location may either be in the local laboratory or another designated space at the site. Supplies needed for processing should be organized in the designated location where processing will be conducted [See Specimen Processing SOP and Supplies List].

Roles and Responsibilities

There are three primary laboratory technicians involved in a serosurvey, each with specific roles and responsibilities.

Survey Laboratory Technician
  • Transporting specimens collected in the field to the Site Laboratory Technician each day specimens are collected
Site Laboratory Technician
  • Inventorying supplies received from central lab
  • Organizing supplies and monitoring inventory during survey
  • Processing and storing specimens at the local laboratory
  • Documenting receipt and location of specimens
  • Documenting receipt and location of specimens
  • Senior laboratory staff may also be involved to oversee the technician performing the tasks
Central Laboratory Techniciansa
  • May support training survey field team members on specimen collection.
  • May engage with site leadership to coordinate shipment of supplies and transport of specimens from the local laboratory to the central or national laboratory.

a Based at the central or national laboratory where testing is conducted.

Figure 2. Laboratory Roles and Responsibilities

Receiving the specimens

At the end of each day of specimen collection the Site Laboratory Technician should receive the specimens from the survey team. If DBS are being used, this may be every few days.

Checklist for receiving specimens at the laboratory
  • Were all specimens collected in the field transported to the laboratory? May use field tracking logs to confirm receipt of all specimens.
  • Were the specimens transported appropriately to the local laboratory? Will vary on the specimen type (e.g., venous specimens should be properly packed in a cold box with ice packs but not in direct contact with ice packs; dried blood spots should be packed in individually labeled containers)
    • If not, Site Laboratory Technician should communicate any issues to site leadership
  • For venous specimens:
    • Can the specimens be processed same-day, or will they require overnight storage?
    • Do specimens need to be centrifuged (if not centrifuged in field)?
    • Were any specimens hemolyzed (observed after serum has separated)?

Specimen Processing & Storage

[Specimen Processing SOP and Training Slides]

  • As with specimen collection, protocols for specimen processing and storage will differ based on specimen type. Regardless of the specimen type, laboratory staff should follow safety procedures when handling biological specimens [LINK TO SAFETY REFERENCES].
  • An SOP should be created guiding specimen processing and transport procedures after collection based on the type of specimen collected for the serosurveys.
    • Specific areas of importance:
      • Where the whole blood or capillary blood will be processed to isolate serum
      • Time limits from blood collection to processing
      • Protocol for the timely and proper storage of specimens, including temperature range for storage
      • Protocol for the timely and proper transport of specimens, including cold-chain and packing information.

Below are considerations for processing whole blood to serum for IgG antibody detection by EIA

  • Whole blood should be received in a sterile tube labeled with participant ID number.
  • To isolate serum:
    • Whole blood should be allowed to clot after collection (for ~1 hour) and then centrifuged at 1000 × gravitational units (g) for 10 minutes to separate the serum.
      • If specimens will be centrifuged in the community prior to transport the Site Laboratory Technician should check all specimens upon receipt to confirm serum has separated; if not, centrifuge again.
    • Remove serum with a fine-bore pipette and transfer to a cryovial labelled with key details about the specimen (e.g., participant ID, date of collection, specimen type)
    • At the time of processing it is recommended to observe and record additional details about the specimen, such as signs of hemolysis and estimated specimen volume (Figure 3).
    • After aliquoting, serum can be stored at 4−8°C for up to 7 days before testing. If kept for longer periods, serum should be frozen at -20°C or lower. Serum should not be thawed once frozen until intended for biomarker testing. Repeated freezing and thawing should be avoided to preserve quality of antibodies.
    • Store labelled cryovials in cryoboxes and record relevant details in a laboratory register and freezer box map (see below section on Documentation). If there are multiple aliquots for specimens, store each aliquot in separate boxes so that they may be shipped separately (done to ensure backup specimens are available in case of issues during shipment).
      • Prior to survey start, develop a standard method for organizing specimens within the cryobox.

Figure 3. Processing of whole blood specimens

Click on photos to expand.

Whole blood specimen prior to serum separation
Whole blood after serum separation
Example of labelled cryovial
Organizing specimens in freezer box

Figure 4. Examples of hemolysis, ranging from mild (light pink) to moderate and severe.

Dried blood spots (DBS) on filter paper cards (e.g. Whatman 903 Protein Saver filter cards) can be used to collect blood specimens. Below are considerations for handling dried blood specimens (DBS) specimens after collection.

  • Following collection, the survey laboratory technician should place each DBS specimen in an individually labeled re-sealable plastic bag with a desiccant to avoid contamination.
  • Upon receipt at the local laboratory the site laboratory technician should remove each card from its bag and allow the specimen to air day for 1-4 hours at room temperature (20-25°C). Where possible this should be done in a dust-free area, such as inside a fume hood, to minimize exposure to contaminants during drying. Note: procedures may vary depending on the DBS device selected [link to references for handling 903 cards].
  • At the time of drying, it is recommended to observe and record additional details about the specimen, such as number of spots and size/quality.
  • After DBS specimens have dried, return to labelled plastic bag with desiccant and store in a cool place at the local laboratory.
  • Temperature: If room temperature is above 25 °C then DBS specimens can be placed in the refrigerator. Always transition specimens from warmer to colder temperatures (e.g., room temperature to 4 °C to -20 °C). Moving a specimen from a colder temperature to a warmer temperature may expose specimen to moisture.
  • Humidity: Specimen quality may be impacted by humidity. If humidity is a concern, store DBS specimens in an airtight container with additional desiccants. Use a humidity monitor placed near the specimen to track daily fluctuations in humidity.
  • Further processing of the specimen (elution to obtain serum specimen) typically occurs at the time of testing. Refer to Assay Protocols module for more details.
Figure 5. Dried blood spot cards set to dry overnight. Recommend placing the card on top of its labelled resealable bag to prevent mixing up bags across specimens.
Figure 6. Grading quality of dried blood spots collected on Whatman 903 card. Top card shows 100% filled for spots 1-4 and 75-99% filled for spot 5. Bottom card shows <50% filled for all spots.

Documentation of Specimens at Local Laboratory

Accurate and complete documentation of specimens is critical to the success of serosurveys. Documentation at the local laboratory may come in multiple forms (see below; refer to Toolkit materials). When possible, additional staff from the site or the survey field teams should support the site laboratory technician with labeling, documentation, and organization.

Label placed on the cryovial (venous specimens only): At a minimum this should include participant ID, date of collection, and specimen type. Labels should be designed for use in freezers, and all handwriting should be done using waterproof markers. Where possible, participant ID and specimen type should be pre-printed (refer to Specimen Collection module for Toolkit materials for generating labels).

Click on photo to expand.

Freezer Box Map (venous specimens only): Used to record where every sera aliquot is stored in freezer. This map is provided to then testing laboratory when shipping specimens [refer to Freezer box map template and Freezer box label template tool].

Click on photo to expand.

Figure 7. Freezer box map

DBS specimens can be organized by geographical area (i.e. cluster/district/province) or dates of receipt. Whatever method of organization in boxes should be recorded in the log, so they can be easily located.

Paper-based lab log or register: This register should be completed at the time of specimen receipt and processing.

Click on photo to expand.

Figure 8. Paper-based lab log or register

Electronic version of the lab register: The central laboratory may request an electronic version of the register that can be shared by email to allow for data monitoring. This will include the same details as the paper lab log.

  • To ensure standardization and minimize data errors, the central laboratory should provide a template where fields are designed to accept the expected format (e.g., date fields must be entered in a pre-specified format) [refer to Electronic laboratory register tool].

Shipping Specimens

Specimens should be shipped to the central laboratory for antigen testing as soon as possible.

  • Shipment may be done via courier system or by hand-carrying specimens via road or plane.
  • Contact staff at the central laboratory prior to shipment. Inform the central laboratory of the quantity and type of specimens being shipped and date of shipment to ensure staff and equipment preparations can be made for receipt, storage, elution, and analysis.
    • Ensure someone from the receiving laboratory will be available to receive and document the specimens before finalizing the shipment date.
  • For international shipments:
    • Understand the permits required by the national government of the receiving laboratory, and develop a protocol to ensure these requirements are met prior to shipping.
  • For shipment via courier company:
    • Inform the courier of the type of specimens to be shipped and clarify the handling procedures and required documentation prior to shipping.
      • Refer to the updated International Air Transport Association regulations pertaining to the Transport of Infectious Substances (add hyperlink) or other resources as needed
    • Defer to courier company for appropriate documents needed for invoicing and shipment [refer to Example courier invoice (sera and DBS) and Shipping label template].
  • Shipment considerations:
    • Identify the correct class, shipping name, UN number for each specimen type, and packaging and exterior box labelling requirements based on the specimen type [refer to Specimen Shipment Training slides, REF – WHO SHIPMENT GUIDELINES].
    • Determine what shipment storage temperature is required, dependent on the specimen type.
    • Recommend triple packaging system for packing specimens [REF -WHO REFERENCE FOR SHIPPING]

[Toolkit-Specimen Shipping Protocol]

Figure 9. Example of triple packaging system for serum aliquots


Section Toolkit material Context
Processing Specimen Processing SOP Survey with sera and DBS specimen collection
Processing Specimen Processing Training Slides Survey with sera and DBS specimen collection
Processing Freezer box label template Survey with sera specimen collection
Processing Freezer box map template Survey with sera specimen collection
Processing Electronic laboratory register Survey with sera specimen collection
Shipment Specimen Shipment SOP Survey with sera and DBS specimen collection
Shipment Specimen Shipment Training slides Survey with sera and DBS specimen collection
Shipment Example courier invoice (sera and DBS) Survey with sera and DBS specimen collection
Shipment Shipping label template Survey with sera and DBS specimen collection