Tuesday, January 4, 2011

Know Thy Lab Tests

It happened again.

After a 3 1/2 hr drive, an appointment and a blood draw in which they took 9 tubes of blood... AND I reminded the tech to protect one of the samples from light... I got a call from the clinic that I needed to come back for a re-draw on the light protected sample because it wasn't frozen.


When I got there, none of the techs knew the sample needed to be immediately protected from light, or even how to accomplish that (tin foil around the tube).  They were very nice, but had to take quite a bit of time to call the lab for confirmation of the need for light protection and freezing due to my gentle persistence that their written instructions for the test mistakenly did not include this information.

This has happened to me too many times to begin to count.  One time I had to have blood drawn for the same test 3 different times during a single afternoon because the techs didn't believe me that the tubes needed to be handled specially.

So here's how most labs work:

The doctor orders a test.  The lab receives the order.  They must look up the directions and supplies for each test.  Common tests are memorized, but less common tests require the tech to go to specially prepared information created by the lab where the blood work will be sent.  Most labs have a printed manual with these instructions, but they can also sometimes go online to the lab site for instructions as well.

Blood is drawn in a special tube according to the instructions and the specimen is prepared.  If it is to be shipped it will often be cooled or frozen prior to being boxed up for a courier to get it started on its journey to the main lab where the test will be performed.

When the lab receives the sample they may check it for compliance to instructions.  For example: if instructions require it to be frozen and it's thawed, it will be flagged as discarded.  The drawing lab will be notified and patients recalled for another draw.

Here's where it gets dicey:

Labs must update their instructions frequently... and appropriately.  They MUST READ them before drawing the blood or the test may not be accurate.  They may try to fudge if they've goofed because they don't want to ask you to come back. FUDGING A TEST WILL RESULT IN INACCURATE RESULTS AND THE POTENTIAL FOR INAPPROPRIATE DIAGNOSIS OR TREATMENT!!

An example is the test we were re-running.  When the techs later go to box up the sample and notice it is supposed to be protected from light they will go ahead and put it in an amber tube for shipment.  This may be an hour after the draw.  Samples that say "immediately protect from light" mean just that - IMMEDIATELY.  They are ultra-sensitive to uv light and degrade very quickly.  Most labs are filled with uv light from the fluorescent lights placed all over the ceiling.   You or the lab the sample is being shipped to will not be aware this has happened and your results will not be accurate nor discarded.

Sometimes labs will notice a problem, discard a sample and simply not call you back in for a redraw.  We have even paid for tests that were discarded and never run... something I would never have known had I not checked up on them when I didn't receive the results I expected.

Sometimes the test will be done and a notation will be added that the results are not to be considered accurate.  These notations are rarely noticed by doctors and nurses who are in a hurry and only looking for actual test results.  It is unlikely you will ever know this has happened unless you are getting paper copies of your original lab reports.

It's up to patients to find out the requirements for the tests they are having run.  Most don't even consider doing this, but typing a quick search for the name of your test plus the search term "lab requirements" or "lab instructions" will often yield helpful instructions.

A proactive patient will observe the draw to be sure special instructions have been carefully followed.  A proactive patient will also often remind the lab tech before the draw that special instructions are necessary for the sensitive test, then watch to be sure they are followed to the letter.  If you know a special instruction needs to be followed that isn't being followed, ask the tech to see the written instructions for the test.  If you believe them to be wrong (and sometimes they really are!) ask them to phone the lab and speak to them personally for confirmation.  They will be aggravated, but if you are right and they are wrong, you have just saved yourself time, money, a little pain and some blood.

A good patient will take the time to talk to and thank their lab tech for putting up with you telling them their job.  Secretly this same good patient will also know that the test was run appropriately and they are getting proper treatment or diagnosis.

I wish I could say that mistakes like these don't happen very frequently.  With common tests, mistakes like these really are rare.  With less common tests they can happen very frequently.

All labs are not created equal, and patients need to be sure the lab they're using has a good reputation for doing things correctly.  The only way you'll know for sure is to stay on top of things yourself.  You care about your health and your health care dollars, so follow through.  Be thorough, at least as thorough as you'd expect your doctor or nurses to be on your behalf.  Please don't expect anyone else to care more about you than you do.

Comment by Janeen on January 8, 2011 at 4:46pm
This is a really informative post!  I usually do my homework about procedures that I have done, but for some reason lab tests never entered my mind.  Thanks for sharing.  I will do my homework on lab tests too from now on.

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