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Case Study #1
Huge quantities of blood are often collected from critically ill patients in the intensive care unit (ICU). Several studies have shown that iatrogenic blood loss due to laboratory testing can result in increased number of hospital deaths due to stress on the cardiovascular and respiratory systems. As an example, Anthony, and 80-year-old man with a massive heart attack, was admitted to the ER and then the ICU. The first laboratory tests were ordered in the ER for CK and Troponin T and other cardiac assays. Also, a CBC was ordered and coagulation tests. Over the next few days, Anthony developed complications, and as each specialist was consulted, more blood tests were ordered. Blood was collected with each order. After a week in the ICU, a STAT laboratory requisition for type and cross-match of two units of packed red cells was received in the laboratory. Anthony had developed iatrogenic anemia.
1. Which vacuum collection tube cannot be used to collect for the CK, Troponin T, and other cardiac assays since it contains fluoride, an additive that could destroy the analytes and thus interfere with their testing?
2. Which vacuum blood collection tubes should be used for collection of blood for the CBC and coagulation studies? What is important to remember about filling these tubes?
3. Which vacuum blood collection tube should be used for collecting the blood to go to the blood bank for type and cross match?
4. What is iatrogenic anemia, why did it develop, and how could it have been prevented in this patient?