RN draw results in strange CBC results....

[Lah66]

Hi everyone,

I am wracking my brain trying to decipher this patients results. Every morning for the past three days his CBC showed a WBC of around 13.5, hgb of about 8.5 and plt count of around 325. The fourth day his WBC had dropped to 8.5, his hgb jumped to 13.5 and his plt count went down to 200. The next two days, his WBC was again around 13.5, his hgb went down to around 8.5 again and plt count went back up to around 325. Fiirst thought was they drew the wrong patient, but his rdw and mpv are right on, even the differential matched. All the tubes typed as A neg. The samples were repeated on two different LH 750's with the same results. I assume the problemis with the phlebotomy. What could the RN have done to the sample to get these results? If she drew the blood and set the syringe down and the cells started to settle and a clot began to form....and then she filled the edta tube without mixing.. Does anyone have other ideas??

Thank you for your thoughts!

[Dpeterson]

I had this happen once. A processor had taken off some Plasma for a Homocysteine and put the tube back in the extra rack. The floor called and added on a CBC. The tech went back and got the tube and ran the CBC. Upon redrawing the patient, the values went back to the original values. Did this patient have any send out that required EDTA plasma?

[Lah66]

I could see that happening! The patient had only a CBC drawn at this time.....I am perplexed. My pathologist is perplexed too! Time for some phlebotomy education for our RN's....Thanks for your input!

[cryan]

i have had the same problem once and it was really getting me so confused i though i was doing something wrong and it really bothered me for a while but i figured it was a practice that the nurse was doing that made the results weird too.you could probably have some retraining or orientation regarding phlebotomy once in a while to be sure that they still practice the proper techniques.

[Lah66]

I agree cryan! I need to just let it go....and get those nurses retrained! I know our instruments are working great! Thanks for the input!

[SMILLER]

I would say that it was a problem with the draw--the syringe-left-standing-for-two-minutes thing is an ongoing problem with decentralized phlebotomy.

As for running the specimen after plasma was removed for some other chemistry test--I don't see how that would cause the WBC to go down AND the Hgb to go up--if anything, all counts would go up.

Often its not the current specimen that's bad but the last one. In this case, apparently all were the same blood type--but that does n ot prove that the odd draw was the right patient--you just cannot say for sure that it is not.

I think an important note, though, is about delta checks. When the Hgb jumped up 4 grams in one day, the tech should have confirmed with the RN before releasing results. Here, we would check with our own BB first to see if the patient has been transfused. If not, the redraw would have avoided releasing the crappy results.

[Mabel Adams]

I once saw a specimen drawn on a baby that showed a terribly low plt count and hgb. We were afraid we would have to transfuse the baby! We checked with the phleb and she confessed that she had fished a clot out of the specimen because she didn't want to have to restick the baby and she knew we would reject the specimen if we found a clot in it. Not the same results as your patient, but never underestimate the creativity out there.

[Lah66]

Unfortunately there is a lot of creativity out there coming from people who do not quite understand what we do...

I can see the WBC and plts falling in the sendout pouroff situation....if you pipette too close to the rbc/plasma interface, you will pick up wbc's and plts in the plasma...so the resulting plasma would have high reds, low whites and low plts....i wish my situation was that easy to explain. Tthanks for all of your input.