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 $101.75  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.

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 specimens, 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. 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.

2. 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. 

3. 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.

4. STERILIZE the skin with alcohol. WIPE DRY with a sterile gauze pad.

5. 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.

6. ALLOW A LARGE DROP OF BLOOD TO ACCUMULATE; wipe away with a sterile gauze.

7. ALLOW A SECOND DROP OF BLOOD TO ACCUMULATE, then APPLY THE DROP TO ONE SIDE OF A CIRCLE ON THE NBS COLLECTION CARD.

8. 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 five 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.        

9. AIR-DRY BLOOD SPOTS THOROUGHLY AT ROOM TEMPERATURE (about three hours) on a flat surface.