"unbelievable" lab results

Specialties Pediatric

Published

I once had an oncology patient admitted for bloody stools. I have known this particular patient for about a year. When I saw him that night, I immediately drew a CBC & type & screen on him - he was the color of vanilla ice cream. He had a Hickman so drawing lab was no problem. About an hour later, hematology called me and said my specimen was obviously contaminated. I needed to re-draw it. Okay, I always assume the first time is my fault. Although I have been doing lab draws for over 10 years, it's possible for me to make a mistake. So I re-drew the CBC. An hour later, I get the same call. Now, I can't make the same mistake twice in a row so I asked what the results were showing. They said the hemoglobin was less than 3 which is incompatible with life. I told them that's why I drew a type & screen, so now I wanted to transfuse. They said I couldn't without a valid CBC. that the specimen was obviously diluted as the platelets were only 10,000. Could we get a peripheral stick (since they obviously thought I didn't know how to do a line draw)? I said no way if his platelets were only 10.000. I had to get the attending physician to call the pathologist in blood bank to release a unit of blood without another CBC. It took me a total of 3 1/2 hours to get that transfusion started and ended transfering him to the unit during the transfusion with bp of 43/22. All because hematology wouldn't believe my lab results.

This isn't the first time I have re-drawn lab because the results are so bad the lab wouldn't believe them, even though their clinical presentation supports the results. It delays treatment and endangers the patient. Has anyone else had this problem?

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Specializes in Utilization Management.
This isn't the first time I have re-drawn lab because the results are so bad the lab wouldn't believe them, even though their clinical presentation supports the results. It delays treatment and endangers the patient. Has anyone else had this problem?

I haven't had this problem, but you might want to make an incident report to Risk Management about it. They'd be interested to hear of unnecessary delays in treatment caused by problems like this.

It took me a total of 3 1/2 hours to get that transfusion started and ended transfering him to the unit during the transfusion with bp of 43/22. All because hematology wouldn't believe my lab results.

Please bear in mind that I don't do pedes or onc, so be gentle, but with an H&H like you got, wouldn't the child have been eligible for a transfer to the ICU regardless of when the blood got there?

Just curious.

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Specializes in Maternal - Child Health.

Is this a pediatric hospital, or one which has an active and busy pediatric heme/onc service?

The reason I ask is that I've worked in pediatric specialty facilities where this kind of delay would never occur, because the lab techs are well versed in the ins and outs of pediatric lab values, especially as they pertain to very sick children. They may call and ask for clarification on a child's condition to correlate it with the lab values, but would never delay a needed treatment based on a value that can be explained by a child's clinical condition.

I've also worked at community hospitals (which rarely saw pediatric specialty patients) where the lab (and other departments, too) were thrown so off course by an unexpected value, that they literally couldn't function.

I think it has to do with their level of experience and comfort in caring for these specialized and critically ill children.

May be time for a department inservice.

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Our lab is used to called us (an onc unit) with abnormal values. They bring it to our attention if there is a drastic change from the previous day's labs, but I've never had a problem with treatment being withheld due to lab values.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I always redraw outrageous results, or even ask the lab to redraw. Better to confirm than treat a bad specimin. Of course, if the patient's crashing that's another thing.

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Is this a pediatric hospital, or one which has an active and busy pediatric heme/onc service?

We're a "chi;dren's hospital within a hospital." We have an active Peds hem/onc service. I believe there are only two peds oncology centers in my state, and I work at one of them. I do agree it is better to re-draw than to treat based on a false lab. That's why I always assume the first bad result is my error (although that hasn't been the case yet). It's when they want the lab drawn a THIRD time that I object. With this particular case, looking at the child, you could tell he needed a transfusion. Even if I had the specimen diluted to half strength, his hgb of 2.7 would really be 5.4 - still in dire need of a transfusion. That's why I feel they should have accepted the hgb as "low" even if they didn't believe it was

Enough venting for today - at least about this topic.

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