Still More Lab Common Sense
The ED insists they sent a light green tube for COMP to the lab for testing but lab did not receive it. Name three locations in the lab the tech/processor should check to try and locate the tube.
Centrifuge
Rack by centrifuge with balance tubes
Tube station/empty tubes
Trash with empty biohazard bags
A type of yeast that can cause severe illness and spreads among patients in healthcare facilities and is often resistant to antifungal medications
Candida albicans, Candida auris, Candida krusei, Candida parapsilosis
What is Candida auris?
A patient is a known platelet clumper. What specimen can be collected to get an accurate platelet count? What do you need to do to the platelet count that comes off the analyzer?
Collect blood in a light blue (sodium citrate) tube. Multiply platelet count from blue top by 1.1 to get platelet count.
Useful chemical test for the diagnosis of hairy cell leukemia
Peroxidase test, Sudan Black test, periodic acid-Schiff test, tartrate-resistant acid phosphatase test (TRAP)
What is TRAP?
tartrate-resistant acid phosthatase
HDL = 55
What is normal?
40-59 mg/dL
You are working in coagulation lab and receive a light blue top tube that is not completely filled to the line. There is plenty of plasma to run the PT/PTT. The phlebotomist tells you the patient is a very difficult draw. Should you run the coag tests and release results with a comment that the tube was not filled?
NO, specimen must be recollected.
Major cause of antibiotic-associated diarrhea. Thrives in patients who are taking or recently took antibiotics
C diff, E coli, S aureus, Group B Strep
What is Clostridioides difficile (C diff)?
A patient has cold agglutinin disease. What can be done to run a CBC on this patient?
Collect the specimen in a lavender top and immediately wrap in a heel warmer to keep the blood at body temperature. Get to the laboratory ASAP for testing.
What feature would NOT be expected in pseudo-Pelger-Huet cells?
hyperclumped chromatin, decreased granulation, normal peroxidase activity, abnormal neutrophils
What is normal peroxidase activity?
TSH = 5.000 mIU/mL
What is Increased?
0.550-4.780 mIU/mL
A patient had a Basic Metabolic panel collected at 0800 this morning. It is now noon, and you get a request to add a potassium to the specimen collected at 0800. Should you do this? Why or why not?
NO, you should not process the potassium as an add-on test. The Basic Metabolic panel done at 0800 includes a potassium level, so you would essentially be doing a duplicate potassium.
Gram positive cocci responsible for difficult to treat infections due to antimicrobial resistance
MRSA, E coli, N meningitidis, Lactobacillus
What is MRSA (Methicillin-resistant Staphylococcus aureus)?
The NICU has a premature newborn and they need to collect a specimen for coag testing (PT/PTT). They are unable to collect a full light blue top tube. What, if anything can be done?
Make a special tube for the baby:
Add .1 mL of 3.2% Sodium Citrate to a plastic pour off tube.
RN or MD will add 0.9 mL of blood to this tube.
MCHC over 36 g/dL is frequently found in
hereditary spherocytosis, lipemia, active cold agglutinin disease, all of the above
What is all of the above?
What is Normal?
11-32 umol/L
You are helping out in the receiving area while staff are on break. You receive a pink top for a Type and Screen. There is a collector ID on the tube and a phlebotomist comes up to you and says they verified that collection and they want to add their ID number to the tube as verifier. Should you let them do this and accept the specimen for testing?
NO, you cannot accept this specimen for testing. You do not know if the verifying phlebotomist was present during the identification and labeling process. This specimen must be recollected.
Superbug affecting patients in long-term health settings, organ transplants, and ICU's. This strain is resistant to vancomycin.
VRE, MRSA, P aeruginosa, Candida albicans
What is VRE (Vancomycin-resistant Enterococcus)?
Double spin technique
Centrifuge specimen (just like other blue tops), remove plasma (careful not to disturb buffy coat). Perform a second centrifugation on the plasma. Transfer plasma to another tube (leave about 250 uL in the tube). Run platelet count on your double spun plasma; should be <10,000
What are these results compatible with?
RBC=6.5, HGB=13.0, HCT=39, MCV=65, MCH=21.5, MCHC=33%
Iron deficiency, pregnancy, thalassemia minor, beta thalassemia major
What is thalassemia minor?
PTT = 40 seconds
What is Increased?
23.0-36.0 seconds
You are working in hematology lab and a processing tech brings you some tubes of csf that are not labeled. The specimen labels are in the specimen bag but are not on the individual tubes. Should you reject these specimens and have them recollected?
You should contact the person who collected the specimens (and/or ordering provider). If they are certain the specimens belong to their patient you can have them come to lab and fill out a specimen accountability form since this is considered an irretrievable specimen. If they do not remember, then the specimen will need to be recollected.
This encapsulated, gram negative rod superbug creates problems for those with weakened immune systems, or chronic lung disease.
C albicans, S epidermidis, P aeruginosa,
S pettenkoferi
What is multi-antibiotic resistant Pseudomonas aeruginosa?
You are working in microbiology lab and you have a tissue specimen with an order for a culture. What do you need to do with tissue specimen?
Homogenize using sterile disposable tissue grinder.
Characteristic feature in folic acid deficiency:
macrocytosis, target cells, basophilic stippling, rouleaux formation
What is macrocytosis?
WBC = 25.5 x103 uL
What is Increased?
4.0-11.0 x103 uL