A phlebotomist is sent to collect a CBC specimen on a 5-year-old pediatric patient. The patient has an IV in the left forearm. The right arm has no palpable veins so the phlebotomist decides to perform capillary puncture on the middle finger of the right hand. This is the phlebotomist’s first job and, although he is quite good at routine venipuncture, he has not performed very many capillary punctures. The child is uncooperative and the mother tries to help steady the child’s hand during the procedure. The phlebotomist is able to puncture the site, but the child pulls the hand away. Blood runs down the finger. The phlebotomist grabs the child’s finger and tries to fill the collection device with the blood as it runs down the finger. The child continues to try to wriggle the finger free. The phlebotomist finally fills the container to the minimum level. When the specimen is tested, the platelet count is abnormally low. A slide is made and platelet clumping is observed. A new specimen is requested. Hemolysis is later observed in the specimen. Questions: 1.) How might the circumstances of collection have contributed to the platelet clumping in the specimen? 2.) What most likely caused the hemolysis? 3.) What factors may have contributed to the specimen collection difficulties
A phlebotomist is sent to collect a CBC specimen on a 5-year-old pediatric patient. The patient has an IV in the left forearm. The right arm has no palpable veins so the phlebotomist decides to perform capillary puncture on the middle finger of the right hand. This is the phlebotomist’s first job and, although he is quite good at routine venipuncture, he has not performed very many capillary punctures. The child is uncooperative and the mother tries to help steady the child’s hand during the procedure. The phlebotomist is able to puncture the site, but the child pulls the hand away. Blood runs down the finger. The phlebotomist grabs the child’s finger and tries to fill the collection device with the blood as it runs down the finger. The child continues to try to wriggle the finger free. The phlebotomist finally fills the container to the minimum level. When the specimen is tested, the platelet count is abnormally low. A slide is made and platelet clumping is observed. A new specimen is requested. Hemolysis is later observed in the specimen. Questions: 1.) How might the circumstances of collection have contributed to the platelet clumping in the specimen? 2.) What most likely caused the hemolysis? 3.) What factors may have contributed to the specimen collection difficulties?
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