Hemoglobin and hematocrit were the only two tests ordered and both results seem totally verifiable. Since the technologist had access to the complete CBC on the computer screen, she noticed the disparity in white counts. The change in white count, however, is troubling and alerted the technologist to the possible problems with the sample. She considered these possibilities:

1. Is the specimen clotted or contaminated?

2. Did the same patient have blood drawn for specimen 1 and for specimen 2?

3. How was the specimen obtained?

Both samples were checked for clots. After contacting the floor nurse, the following information was obtained. Both samples were drawn through an arterial line, an "A line." Arterial lines are inserted in critically ill patients who have frequent blood draws and receive frequent medications. The procedure when drawing through an A line is to draw off and discard the first 10 mL of blood and then proceed with the blood draw, usually filling tubes directly from the line. In this case, the blood draw for the first sample was difficult and the blood from the A line was not free flowing. The second sample, however, was obtained without difficulty. proper blood drawing procedure with the A line was followed with both samples. After consultation with the lead technologist and the nurse, it was decided to release the second set of results and remove the first set from the computer. The patient did have a blood bank history and had received units of packed red cells and fresh frozen plasma. This information, however, did not have relevance in this case, considering that the parameter in question was the white count.

142 Part III • White Cell Disorders

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