1. Are you currently using B5 fixative?
   Yes-7   No-12
2. Has your lab used B5 in the past?
   Yes-14  No-5
3. If you have discontinued it's use, when and why?
   *Last year due to mercury disposal issues
   *3 yrs ago, zero tolerance for mercury (environ-
    mental laws)
   *safety and disposal costs
   *hazardous waste
   *prior to 1999, due to high health risk
   *health and waste concerns. Also, our
hematopathologists like the alternatives better.
   *Since the AHA (American Hospital Association) is
working with the EPA(Environmental Protection Agency)
to get all hospitals to voluntarily agree to eliminate
all mercury by 2005, and since our hospital is
thinking about signing on, we will have to switch to
something else. Sooner than 2005, if the hospital
administration and Safety sign on.

I have tried to get our pathologists to change in the
past, but even with the blind experiment where they
basically could not tell the difference between B5 and
a zinc formalin, they still would not let us change.
But if the hospital administration and Safety say we
must change, they will finally agree to it. But not
one minute sooner.

4. What alternative fixative are you using in it's
place?

   *B-Plus-3
   *Prefer from Anatech-1
   *10% NBF-1
   *Z5-1
   *Zinc Formalin-2
   *Bouin's-1
   *Bakers Formalin-1
   *Para-formaldehyde-1

   * I've tried alternatives, with no success. If you
can't use B5 fixative, the best alternative is to
insist on overnight fixation of the specimen in NBF,
rather than trying to process it the same day.
   *We tried Zinc Formalin once as a trial, but it
needed too long to fix. (Overnight) Our Bone Marrows
only need 2 hours in B5.
   *I'm going to play around again. There are more
choices than when I first tested it 6 years ago.

5. Do you need to use the "de-zenk" procedure for this
substitute?
   *no (re:B-Plus)
   *no (re:Prefer)
   *no (re:Zinc Formalin)
   *To de-zenk we have iodine in the 1st Xylene on our
stainer. All sections get it. We don't have to worry
about which consults are B5 fixed.

6. If you use B5 and work in a reference lab; what
percentage of cases require its use?
   *Very small
   *7 Bone Marrows a month
   *5 lymphoma cases per month
   *2%
   *Very low percentage of cases. More if you fix Bone
Marrow Bx's in it. The important thing is to use as
little of it as possible-no more than 10 ml's per
case.
   *We fix all bone marrows and lymphoma cases in it.
You could say all hematopathology cases in B5.
   *We mainly use it on Bone Marrow and lymph nodes.
Around 5-10 cases/week.
   *Now that we use HIER with the IM, we are doing
very few B5 fixed tissues. We used to do at least one
cassette on all tumors that they suspected of cancer.
Now, formalin works fine on most. So maybe 1-2
cassettes a week for cancer..(Out of 3000-4000
cassettes a week) 

However, all bone marrow biopsies are still B5 fixed.

Thanks again for your responses,
Scott Taft HT ASCP
Tucson, AZ








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