A Safe Deposit Facility for Patient Specimens

Dr Khor Ing Wei

A storage facility for blood and tissue specimens seems vaguely ominous at first. Visions of musty cabinets and haphazard freezer boxes may spring to mind. Happily, this image quickly dissipates when you talk to Dr Eng Chon Boon, head of the NUH Tissue Repository (TR).

When you’re dealing with 1.3 million samples and three storage sites, including a warehouse containing more than 40 freezers (with space for 30 more), operations more closely resemble a well-oiled machine than anything else. At this large scale, the TR maintains a high standard by following best practices laid out by the International Society for Biological and Environmental Repositories (ISBER), which promotes high quality standards for global biobanks.

One of ISBER’s recommendations is to continuously monitor the environment where samples are stored. Dr Eng uses two apps on his mobile phone to do this. One app connects to the warehouse CCTV system, enabling 24-hour viewing of the facilities. The other app shows the equipment status and alerts the person on call by phone, SMS, and e-mail if conditions veer out of predetermined ranges. These redundant systems reassure TR customers that their samples are being maintained in optimal conditions.

Which brings us to the customers. Who are they? Some are NUHS researchers who engage the TR to collect, process, and store samples for their own clinical studies and archives. These researchers retain full ownership of their samples. Other customers are researchers who want to make use of the TR’s large sample collection, obtained through patient donation.

Indeed, the TR does much more than just storing samples. Firstly, it collects samples according to ethical guidelines (see Facts Box). If the sample is blood, medical technologists can extract the white blood cells (the buffy coat) and the cell-free liquid (serum or plasma) for storage. If tissue, the in-house pathologist examines it and selects only high-quality samples for storage. RNA and DNA are often extracted from the tissue and stored as well. Samples are then de-identified and labelled with a code corresponding to patient information in the TR database.

These de-identified samples are supplied to the researcher, along with basic patient data like age, gender, race, and tumour stage. Researchers can obtain additional data by contacting TR staff. Cancer researchers are also able to tap into the Hospital-based Cancer Registry, which collects data for all NUH cancer patients.

Not content with being the largest biobank in Singapore, the TR is continually upgrading its equipment and services. For example, it recently purchased a robot to quadruple the number of liquid samples processed at one time. The next big goal is to achieve College of American Pathologists (CAP) accreditation for repositories when it is available outside the United States.

Ethics of Storing Patient Samples and Data

TR follows ethical guidelines, such as those of the Bioethics Advisory Committee, to protect patients’ privacy and rights:

  • Consent nurses explain biobanking procedures and answer questions before obtaining informed consent from patients to collect samples, following the new human biomedical research bill.
  • Services are only provided for research projects with proper ethical approval, e.g., from an institutional review board (IRB).
  • Identifiable patient data are released only to researchers with appropriate IRB approval.

Resources

  1. International Society for Biological and Environmental Repositories. 2012 Best Practices for Repositories, 3rd ed.
  2. Bioethics Advisory Committee, Singapore. http://www.bioethics-singapore.org/.
  3. Hassan NJ. Human Biomedical Research Bill Passed to Protect Research Subjects, Tissue Donors. Channel NewsAsia. Available at: http://www.channelnewsasia.com/news/singapore/human-biomedical-research/2058862.html. Accessed 13 November 2015.

...