How to ship blood

In case this is helpful to anyone, here is my little tutorial on shipping blood.  It is really easy.  We've been doing it as long as I've been a patient at the PPVI Institute.  Different labs calibrate their machines differently, and that can mean the same blood sent to two different labs would give noticeably different results.  For this reason, PPVI doctors require a patient's blood to be shipped to the PPVI lab (National Hormone Laboratory) for analysis there.  This is especially important for progesterone levels as all of the standard curves for NaPro are based on the PPVI lab.

[Side note:  Some NaPro doctors have ordered a set of controls from the PPVI lab to be run at their local lab see how closely the local lab's results compare to PPVI.  This allows the NaPro doctor to create a calibration curve to convert the local lab results into the PPVI standard.  Then all the patients for that NaPro doctor don't have to ship blood to PPVI; they can just go to that particular local lab, and the results will be sent to the NaPro doctor like any normal blood draw.]

First you have to find a lab that is willing to let your blood sample to leave their lab and go to another lab for analysis.  Not all labs allow this.  I have had the most luck with hospital outpatient labs; I have mailed blood to PPVI from two different cities.  The independent (not connected to a hospital) labs have all turned me down when I called to inquire about this.  So call around to your hospital lab(s) and ask if they are willing to just draw your blood and centrifuge it and then mail it to another lab for analysis.  You can also ask if they would let you mail the blood yourself (after it has been centrifuged).

In the first city where I lived, the lab was reluctant accommodate my request, but one of the lab admins said she remembered they had done this for a patient who was part of a research study, so in the end they agreed.  After taking down the name of the person giving me permission over the phone, I went to have my blood drawn at that lab and had to re-explain everything to the person drawing my blood.  The phlebotomist was hesitating, but as soon as I said it was for a research study, she stopped questioning me immediately and became very understanding.   Technically the PPVI Institute does do research so it's not totally wrong to say my blood draw was for research.  (Sorry for encouraging little white lies...)  I don't know why "research" was more acceptable than "my doctor wants to use her lab because it's standardized."  PPVI has written instructions on the back of the requisition form (blood draw order form) on how the blood is to be centrifuged before it is mailed, so I reviewed that with the phlebotomist before I left.  I didn't leave until I was confident that my sample was not going to be analyzed in town at that lab.  They promised to mail my blood to PPVI.

In the second city where I live now, the lab admin I spoke to on the phone was much more willing to cooperate.  He even sent an e-mail to all his phlebotomists letting them know that I was coming and what I would be asking for.  When I arrived with my requisition form in hand that PPVI had mailed to me, the phlebotomist said, "Oh, you're the girl we got an e-mail about," and she pointed to a printed copy of the e-mail.  What great service.  :)  I was impressed.  They made copies of the requisition form (which is marked as a "standing order" since I need the same P+7 labs each month) and keep in them in a file with the other frequent customers.

Now every time I go, after the staff person retrieves a copy of my requisition form from the file cabinet, I remind him/her that I'm the special case where my blood will be mailed to a different lab.  I rarely get the same phlebotomist, so I point out the written directions and make sure they understand before my blood goes to the lab for centrifuging.  The lab ladies do know the drill by now, and they even remember my name.  (I met them last month when the phlebotomist wanted me to go back to the lab to make sure everything was going to be done correctly.)

When I first started using my current hospital lab for this, they would ship the blood to PPVI for me.  Because it was not a standard request, they didn't know how to bill me, so they didn't charge me at all.  Then the lab manager decided I should be charged (and I agreed), so they did figure out how to bill me a set fee.  After quite a while doing this (maybe a year?), the lab manager decided that the lab was no longer capable of mailing my blood to PPVI.  I have no idea what changed.  They gave me two options:  have the blood analyzed locally or mail the blood myself.  So now after my blood is drawn, I wait for the lab to centrifuge the blood and separate out the serum.  They hand the tube of serum to me, and I mail it at the post office.  I am very spoiled, but they do not charge me for the blood draw or for the centrifuging.

The specific tests you are having done determine whether you can ship the blood at room temperature or whether it needs to be shipped while frozen.

Here are the different colored tubes the phlebotomist
could use. Make sure red is used. (source)

NOTE:  For the routine P+7 progesterone and estradiol, the phlebotomist only needs to fill one red top tube with your blood, not two.







How to ship blood at room temperature

For these tests:  progesterone, estradiol, prolactin, FSH, LH, HCG, and DHEA

As long as the blood will reach PPVI within 5 days, it is okay to send it without anything to keep it cold.

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.  (One time my lab gave me a tube of red blood.  I handed it back to them and said it's supposed to be yellow (the serum).  They apologized for forgetting to separate out the serum and took it back to correct it.)

2.  Put the tube of yellow serum in a ziploc bag.  My lab gives it to me in a ziploc bag with a biohazard symbol on it. 

3.  Put that ziploc bag in a second ziploc bag.  I use a sandwich bag.  Also fold up a paper towel (or some other absorbent material like cotton balls) and put that in the bag as well.  The idea is that the paper towel should be large enough to absorb all the serum if it were to leak out.  The post office requires that the tube of serum be in two "containers" in addition to the mailing envelope, hence the two ziploc bags.

Sometimes my lab used to give me my serum in two
ziploc bags.  I didn't put the paper towel in the bag yet.

4.  Put the bundled up serum in a padded mailing envelope.  Also include the blood draw order form.  Seal the envelope well.  I always use extra packaging tape.

5.  Mail the envelope.  I use the post office for mailing and have it sent as a regular first class parcel, which is the cheapest.  Sometimes the post office clerk asks if the package is liquid, perishable, hazardous, etc., and when you're mailing blood, the answer is yes.  Sometimes they ask further questions to make sure the blood is packaged securely.  I just tell them it is in two separate containers (in addition to the plastic tube holding the blood and in addition to the envelope).


How to ship blood frozen

For these tests:  thyroid, testosterone, and androstenedione

I have only done this twice, and somehow it managed to work out for me.  This is what I did:

1.  Pick up your blood sample from the lab.  It takes a half hour or so for my blood to be centrifuged by the lab after it is drawn, so I usually just wait in the waiting area.  When you receive your blood, make sure the tube contains a yellow liquid, not red.

2.  Put the tube of yellow serum in a ziploc bag.  Put the bag in your freezer for several hours.  (I left it there overnight one time.)  I did this to maximize the chance that the blood would still be cold when it arrived.

3.  Right before you're going to mail the blood, take the bag with serum out of the freezer.  Put it in a second ziploc bag (size of a sandwich bag) along with a folded piece of paper towel or enough cotton balls to absorb all the serum if it leaked.

4.  Put the filled ziploc bag in a large (gallon-sized) ziploc bag.  Also put two ice packs in the large bag.  Seal the bag.

I used two of these ice packs.  The label says it's a "long lasting ice pack."
  The business card next to it is to show scale.

5.  Put the large bag containing the blood and ice packs in a small box.  The box I used was smaller than the size of a shoe box.  Put the blood draw order form in a separate ziploc bag (so it is protected from getting wet) and add that to the box.  Seal the box well with packaging tape.

6.  Mail the box using overnight shipping.  Use UPS or FedEx or some other company.  Don't use the post office because it might not be delivered the next day as requested.

My experience with FedEx
The second time I mailed frozen blood I went to a FedEx store at 5:00 pm.  I had my blood in a small box, but I didn't seal the box in case they preferred that I use a standard FedEx box.  I brought packaging tape and scissors along in case they said I could use my own box.  The store manager said they were not allowed to ship hazardous/infectious things or even sell me the postage/mailing label for my box.  (Technically, blood isn't considered infectious—unless you do have an infection, which I don't—but the fact that it was blood made the manager nervous.)  He said I was free to use the FedEx drop box outside.  He did give me a large clear plastic-like FedEx bag ("clinical pak"), so I taped up my box, put it into the bag, and sealed it.  I filled out a mailing label complete with credit card number and stuck it to the outside of the bag. They would bill me when they picked it up.  I chose next day delivery by late afternoon.  I put it in the drop box.  According to online tracking, the package arrived at PPVI before noon the next day, several hours ahead of schedule.

My experience with the post office
I sent DH to the post office to mail the box with my frozen blood.  It was first thing in the morning on a Tuesday.  It also happened to be the day of a predicted snowstorm, but the post office clerk still said the box would arrive in Omaha the following afternoon.  The receipt even said "guaranteed delivery" the next day.  We had a tracking number.  On Thursday morning, my box was sitting in a warehouse less than an hour from where we live.  It didn't leave my state until Thursday night.  I was upset.  I figured my blood would have been thawed by then and therefore useless.  Friday morning I called the PPVI lab to let them know the situation and asked that they not even do the thyroid tests.  I said I'd send them a new sample later.  Surprisingly the lab tech said my blood had just arrived and it was still cold, so she said they could still do the tests.  I later read online that others complained that the post office's "overnight shipping" was actually 2 or 3 days, so I learned it wasn't just the snow to blame.

If I had to mail blood frozen again, especially if it was summer, I'd prefer to use dry ice.  The lovely Wheelbarrow Rider is more of an expert on shipping with dry ice, and she said you can check the phonebook to try to find a local place to buy some.

How to do an HCG injection

Since I've been on HCG for a while, I thought I'd make a little tutorial of how to give yourself a subcutaneous HCG injection.  HCG is used primarily post-peak to increase estrogen and progesterone levels.  It's one of the first treatments NaPro doctors recommend for PMS.

Make the HCG solution

My HCG comes in a solid form and needs to be reconstituted in water.  The pharmacy sends it this way so it doesn't have to be kept cold during shipping.  The vial contains 10,000 IU of HCG.  I add 7.5 mL of water resulting in a solution where 1.5 mL = 2,000 IU.

*A note about needle gauge:  I've used syringes with a gauge ranging from 20-23 for reconstituting HCG.  It just depends what the pharmacy sent me or what I have on hand.  The larger the gauge, the smaller the needle.

Gather the supplies:  vial of bacteriostatic water, HCG vial, 3 mL syringe, and alcohol wipe(s). 

Remove the plastic cap from the top of both vials.  (They are already removed in the picture to the right.)

Obviously I took the picture on the right after I added all
the water...just pretend you can't see the liquid.

Wipe the top of each vial with an alcohol wipe.

Remove the cap from the needle.  Fill the syringe with air.

Insert the needle into the vial of water.

Flip the vial and syringe upside down.  Press the plunger all the way to inject air into the vial of water.  This will make it easier to fill the syringe.

Pretend this was a picture of the vial of water from
the previous picture.  The concept is the same for
filling the syringe with either water or liquid HCG.

Make sure the needle tip is covered by liquid.  You don't want to draw up any air into the syringe.  Fill the syringe with 3 mL of water.  You will likely have air bubbles in the syringe as you're drawing up the water.  Flick the side of the syringe barrel with your fingernail or knock it gently with your knuckle to force the air bubbles to rise to the top.  Press the plunger upward slightly to release the air bubbles back into the HCG vial.  Draw more water into the syringe if necessary to reach the 3 mL mark.











Remove the needle from the vial of water and insert the needle into the HCG vial.  Inject the water into the HCG vial.  Repeat this again with 3 mL of water.  The third time, fill the syringe with 1.5 mL of water.  This will be a total of 7.5 mL of water added to the HCG.















Invert the HCG vial several times to mix the solution thoroughly.








Write today's date on the vial.  The HCG is good for 60 days from the date of reconstitution.

If you're not giving an injection right away, put the reconstituted HCG in the refrigerator.


Give the HCG injection

*A note about needle gauge:  I've used syringes with a gauge ranging from 22-25 for HCG injections.  The larger the gauge, the smaller the needle.  So go with a 25 gauge needle if you have a choice.

Wipe the top of the HCG vial with an alcohol wipe.  Also use an alcohol wipe to clean the area of skin where you plan to do the injection.  I clean a large area of skin so I don't have to aim for a particular tiny spot.
 
Wait a little while for the alcohol on the top of the vial to dry.  Do not fan it (or your skin) to try to speed up the drying.












Remove the cap from the needle.  Fill the syringe with a volume of air equal to the amount of HCG you want to inject.


















Insert the needle into the HCG vial.  Press the plunger down all the way to inject air into the vial of water. This will make it easier to fill the syringe.

















Flip the vial and syringe upside down.


















Make sure the needle tip is covered by liquid.  You don't want to draw up any air into the syringe.

















**Note:  My prescription says each dose of HCG is 2,000 IU. This is 1.5 mL of HCG according to my directions for reconstitution above.  Adjust the volume accordingly if you are prescribed a different dose.

Fill the syringe with 1.5 mL of HCG.  You will likely have air bubbles in the syringe as you're drawing up the water.  Flick the side of the syringe barrel with your fingernail or knock it gently with your knuckle to force the air bubbles to rise to the top.  Press the plunger upward slightly to release the air bubbles back into the vial.  Draw more HCG into the syringe if necessary to reach the 1.5 mL mark.

Remove the needle from the vial.

Very gently press the plunger until a drop of liquid appears at the tip of the needle.  That way you know you've pushed all the air bubbles out.












Pinch the area of skin you plan to inject with your non-dominant hand.  I do the injection in my outer thigh.  I just can't handle the thought of doing an injection in my belly.



Hold the syringe in your dominant hand.  In a quick motion, like you're throwing a dart, stick the syringe into your (pinched) skin so the needle goes in all the way.**  Press the plunger down to inject the HCG until you've injected all of it.  Remove the needle from your skin.

**If you do the injection correctly, you should barely feel the needle going in.  It can be virtually pain-free.

If you are super careful, put the cap back on the needle.  Untwist the needle to separate it from the syringe barrel.  Put the needle in your sharps container.  Cleaned out, hard plastic bottles work well.  I use an old plastic olive oil bottle.  A laundry detergent bottle would work too.  Throw the needle-less syringe barrel in the trash.

Store the liquid HCG in the refrigerator.  Discard 60 days after reconstituting it if not used.

If you prefer watching a video tutorial, search Y.outu.be.  I watched a few videos before attempting to do the injection for the first time.