Specimen Collection and Rejection
Scenario: A tube of blood arrives severely hemolyzed. What do you do?
Reject the specimen and request a new draw because hemolysis falsely elevates potassium and LDH
Scenario: Temperature of the blood bank refrigerator reads 7.5°C. Action?
Answer: Move blood units to a backup monitored unit immediately and log the failure.
Scenario: Glucose result comes back as 28 mg/dL on an adult. Action?
Answer: Immediately call the critical value to the floor nurse or physician and document the call. Hypoglycemia (Normal Value: 70 to 99 mg/dL)
Scenario: Gram stain shows gram-positive cocci in clusters from a blood culture bottle. Action?
Notify the physician immediately of preliminary positive Gram stain findings. Staphylococcus aureus: A common and aggressive cause of serious bloodstream infections.
The hematology analyzer gives an "error: clog" message. What is the fix?
Run a probe cleaning cycle or flush the aperture.
Scenario: A CBC specimen sits at room temperature for 18 hours before testing. What happens?
Reject it; prolonged storage causes cellular degeneration and false platelet/white blood cell counts.
Scenario: Reagent lot numbers change mid-week. What must you do first?
Run parallel testing on the new lot to verify acceptable correlation with the old lot.
cenario: Serum potassium reads 7.2 mmol/L with a normal ECG context. Action?
Answer: Check for hemolysis or sample mislabeling, then phone the critical high value immediately.
Scenario: A MacConkey agar plate shows no growth, but blood agar shows growth. Suspect?
Answer: Gram-positive organism (MacConkey inhibits gram-positives, only gram Negative grows)
The centrifuge makes a loud banging noise while spinning. What is the immediate action?
Stop the centrifuge immediately and balance the tube loads.
Scenario: A blue-top coagulation tube is only half full. Can you run it?
No, reject it. The improper 1:9 anticoagulant-to-blood ratio alters PT/aPTT results
Scenario: A chemistry QC result falls outside the ± 3SD limit. What do you do?
Do not report patient results; repeat the QC and check instrument calibration or reagents.
Scenario: A needle stick injury occurs with a used phlebotomy needle. First action?
Wash the wound thoroughly with soap and water, bleed slightly if needed, and report to supervisor/employee health.
Scenario: A stool culture for ova and parasites sits unpreserved for 5 hours. Action?
Answer: Request a fresh specimen because trophozoites (causes malaria)disintegrate rapidly
The refrigerator holding blood reagents goes above the safe temperature limit. What do you do?
Move reagents to a working backup fridge and tag the bad one out.
Scenario: A lipemic specimen affects a chemistry panel. How do you fix it?
Use an ultracentrifuge or lipid clearance agent to clear the lipemia before analysis.
Scenario: The hematology analyzer shows background counts above acceptable limits. Action?
Answer: Perform a system rinse and re-run the background blank.
Scenario: Centrifuge lid opens while spinning. Action?
Answer: Never reach in; let it stop completely on its own to avoid aerosolization and severe injury.
Scenario: Acid-fast bacilli (AFB) smear appears blue instead of red/pink. Error?
Answer: Under-decolorization or improper primary staining step (Carbolfuchin); repeat stain
A pipette leaks liquid during transfer. What should you check?
Check if the disposable tip fits tight or replace the pipette seal.
Scenario: A serum separator tube (SST) arrives with no clot formation yet. Can you spin it?
No, spinning un-clotted blood causes fibrin strands to form in the serum.
Scenario: Centrifuge RPM speed checks low using a tachometer. What is the risk?
Answer: Incomplete separation of cellular components and serum/plasma layers.
Scenario: Fire breaks out in the incubator room. What acronym guides your fire extinguisher use?
Answer: PASS (Pull, Aim, Squeeze, Sweep) after activating the alarm and evacuating.
Scenario: Automated urine analyzer flags high bacteria without high WBCs. Action?
Answer: Perform a microscopic check to rule out amorphous crystals mimicking bacteria.
A barcode scanner fails to read a sample label. What is your backup step?
Enter the patient number manually using the keyboard.