Now that I work in a private lab and not a hospital lab, poor collections are less of an issue for a number of factors. While non-lab-staff (who sometimes do collections in certain departments/hospitals) think we are just being huge jerks when we tell them they did it wrong, there are actually very real consequences for a poor collection.

An example is a nice elderly lady who had gone into emergency and the physician suspected she was going into renal failure. Her initial bloodwork gave the following results (reference ranges in brackets):

Creatinine: 40umol/L (50-105umol/L)
Sodium: 148mmol/L (133-146mmol/L
Chloride: 122mmol/L (96-106mmol/L)
Hemoglobin: 97 g/L (120-160g/L)
White blood cells: 4.0x10^9/L (4.0-11.0 x10^9/L)

Based on these results, the creatinine is way too low to fit renal failure. In fact, it is suspect for other metabolic conditions like liver disease. But her sodium and chloride are quite high. Chloride that high can suggest a number of things, including metabolic acidosis. Hemoglobin is low, and it’s around the point where some physicians would want to give a transfusion, depending on the patient status. The patient was admitted and had followup bloodwork 6 hours later:

Crea: 87umol/L
Na: 140mmol/L
Cl: 111mmol/L
Hgb: 122 g/L
WBC: 9.6x10^9/L

That’s… Quite different! The patient never got transfused or anything (and didn’t even really get much treatment, actually) and that is a huge climb in hemoglobin (a full unit of packed cells would only increase her hemoglobin by about 10g/L as it were). The fact that many things have practically doubled would have made the analyzer flag the results as suspect (AKA failed delta). Notice that the sodium and chloride, previously high, have gone down. Overall, her results are actually quite nice.

But we would have to look into the delta flag either way because that is what we do. After retrieving the first sample from the fridge and comparing it to her current sample, you could see right away there was A Problem. No pictures, unfortunately, but the serum was much more dilute, almost clear, on the chemistry tube from her first draw. Not to mention the hematocrit (ratio of blood cells to plasma) was much, much lower on the first collection. 

Knowing that isotonic saline has a sodium of 150mmol/L, the individual who did the first collection had probably skipped phlebotomy 101 and decided it was ok to collect right above an IV site, causing her specimen to be diluted down.

Long time no see, Tumblr! I have been busy with personal things and I apologize.

The first of our month of Instrument Shenanigans, the Tigris, our gen-probe analyzer, is a qualitative nucleic acid test based on transcription-mediated amplification which we use for gonorrhea and chlamydia testing in chemistry. At some point in our run, the instrument got contaminated and about 40 patients all tested positive for chlamydia in a batch run. Chlamydia is pictured above in the vacuoles of a cell off a pap smear (we were actually running urines). 

Luckily, the tech on the bench was astute enough to notice this before results were filed, so it was all resolved in the end.

Yet another lunchroom poster I made (sorry for the watermark).

One of the many posters I made for the lunch room a while back. 

Meet the DxC, we have two named Dixie and Dexter. I’m about to tell you a very convoluted story involving Dexter.

So for the last couple of months, both of them had been kind of acting up, Dixie moreso even though she’s the lead instrument, so Dexter has been doing the bulk of the work. That day, the maintenance guy came to fix them both up, and he was working on Dixie first.

Throughout the day, Dexter had been spitting out random samples without running them because he would error in the middle of a sample and no one knew that he had skipped them (they went through the probes and scanners and everything). 3 hours into my shift, the nurse calls asking for a STAT result sent in at like 6AM (we get 1 hour to do a stat test, it was now 10AM) so one of the chemistry techs starts looking for the sample. She recruits a couple of lab assistants and they’re ripping the lab apart looking for this sample.

11AM is when a whole batch of new collections come in. Dexter is already overworked. He is still erroring. The missing STAT is still missing and we think it wasn’t received.

Then the man who needs to change the water tanks for both instruments arrives suddenly. And he says it will take about 10 minutes tops. Dexter completely crashes at this point and now we have no chemistry analyzers online. And we’re like, okay, let’s just change the tank and get it out of the way since they’re already down.

The DxCs have a reserve tank that can run about 10 tests in emergencies and the reserve is used up trying to recover Dexter from the crash and Dixie is lying in pieces on the counter. The phone is now ringing because the nurses want to know where their test results are.

The water change goes poorly and the lab is suddenly starting to flood. I crawl behind the instruments and hold up all the electrical lines so nothing short circuits while getting slowly soaked with fancy water as the water guy tries to stop the spray.

The stat is still finally found. The new samples are piling up, and now we have to rerun a bunch of the morning’s work because they were never tested at all.

Welcome to the lab?