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You wouldn't ask a Radiologist to try to rule in or rule out pneumonia on a chest Xray of poor quality.

Neither should you ask a lab tech to attempt to interpret an uninterpretable blood smear. The values you receive may be meaningless. What's worse, you won't know whether they're meaningless or not.

Just repeat the test. It's the safest thing to do.

Jim

James Chamberlain, MD
Division Chief, Emergency Medicine
Children's National Medical Center
202.476.3253 (Office)
202.476.3573 (FAX)
202.476.5433 (Emergency Access)


-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Jonathan Schiffman
Sent: Tuesday, February 26, 2013 6:26 PM
To: [log in to unmask]
Subject: Re: rejected samples

I agree completely that I would not have suggested to the nurse ahead of time that she send a clotted specimen.  Similarly, we are looking into ways to reduce our number of hemolyzed samples.  However, I think it is less a matter of "garbage in, garbage out" and more "the enemy of good is best"!
Jonathan Schiffman

----- Original Message -----
From: "Summer Smith" <[log in to unmask]>
To: "Jonathan Schiffman" <[log in to unmask]>
Cc: <[log in to unmask]>
Sent: Tuesday, February 26, 2013 2:41 PM
Subject: Re: rejected samples


Clinical labs do have physicians interpreting the results. They are the 
directors who are clinical pathologists. And yes, they are held to high 
standards because accuracy and consistency are paramount for laboratory 
confidence in patient care.

If you know your sample is clotted, why send it? Seems about equivalent to 
the "garbage in, garbage out" idea of bagged urine samples for culture to 
me.  If small sample size is an issue, consider looking at methodologies 
such as iStat for backup.  They only require a few drops of blood. They are 
also incredibly helpful for emergent patients.


Summer Smith, MD
PEM
Rocky Mountain Hospital for Children
Denver, CO





The journey is the destination.

On Feb 26, 2013, at 6:17 AM, Jonathan Schiffman <[log in to unmask]> wrote:

> I am having an issue with the laboratory in my hospital with regards to 
> rejected specimens.  This is more of an issue with regards to electrolytes 
> and hemolyzed samples, but is also an issue with CBCs.  If a sample is 
> hemolyzed, our lab wants to reject the entire sample and tries to refuse 
> to report any values, whether or not they will be affected by hemolysis! 
> Alternatively, I had a case where a CBC was sent even though the blood 
> clotted before getting into the microtainer.  The lab notified us that the 
> platelets were low.  When the nurse explained to them what happened, they 
> decided to reject the entire CBC on the theory that maybe the WBCs were 
> not entirely accurate either!  As much as I laud the laboratory for their 
> high standards and desire to report only the most accurate numbers, it 
> also drives me crazy that I can't get the information I need.  Since when 
> is the laboratory deciding how to interpret the results of the tests 
> instead of the physician?  In every hospital I have ever worked the lab 
> simply reported that the specimen was hemolyzed (or platelets clumped), 
> gave me the numbers anyway, and let me decide what action was needed. 
> What is the policy in your hospital?  I am completely in the wrong in 
> wanting to be able to have more control of the decision making process 
> with regard to whether a child needs to be stuck again?!
>
> Thanks for your input!
>
> Jonathan Schiffman
> New Jersey
>
> For more information, send mail to [log in to unmask] with the 
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html 

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html