Specimen centrifuged with red cells above plasma

[Mabel Adams]

Has anyone seen a specimen where the red cells were above the plasma after it was centrifuged?  The patient was in cath lab and then went for a CABG.  I asked our Pharmacy intern to research what meds he got that were more dense than red cells and they said, "the only two agents that are denser than RBCs on the patient's MAR are Calcium chloride (100 mg/mL) and Isovue".  The Isovue contrast material is not charted for before the specimen was drawn but later during the CABG.  I suspect that is the culprit. His Hct here looks to be about 25% but the redrawn specimen had a Hct of about 45 so I think there was very dense IV fluid in this specimen.   Does anyone have similar experience?  BTW, this plasma created very junky reactions in gel and interfered with the tube reverse type.

  

[jayinsat]

Very interesting. I would have recollected that specimen since it was contaminated. I have never seen anything like this though. Thanks for the share, and the pics.

[AMcCord]

I have seen issues with tube testing on one patient that I suspected was due to contrast media. I don't remember was was used but do remember that it was administered about 30 minutes prior to our specimen collection. When we recollected the specimen about 4 hours later, no problems.

[applejw]

I wouldn't think they would use contrast during CABG - my guess is that it was given prior to Cath Lab but charting caught up later after patient went to the OR. I've never seen a specimen like that - very interesting.

[Jsbneg]

Very interesting. Thanks for sharing this. I've never seen such phenomenon.