Presented By: Dr. Nathan Heinrich, DVM, DACVP - Lab Error Quick Reference
| Error / Finding | What It Looks Like | Common Causes | How to Detect / Prevent | Supporting Quote from Lecture |
|---|---|---|---|---|
| False Hyperkalemia PRE-ANALYTICAL | Elevated K+, low Na:K ratio; may mimic Addison's disease in young animals | Thrombocytosis (platelets release K+ during clotting); EDTA contamination from purple-top tube; delayed serum separation | Repeat on heparin plasma or i-STAT (whole blood); check platelet count; draw red-top before purple-top; separate serum promptly | "If we don't get our serum quickly off of that red cell and platelet pellet, those platelets are going to release potassium into the sample." |
| EDTA Contamination PRE-ANALYTICAL | Spurious hyperkalemia; may falsely decrease calcium; affects chemistry panel | Drawing purple-top (EDTA) tube first, then red-top with residual EDTA on needle; human studies show 3-6% of hyperkalemic samples are EDTA contaminated | Change blood draw order (red-top before purple-top when possible); use fresh needle for chemistry draw; consider human medicine draw order guidelines | "If we drew our purple top first, and we got even a tiny bit of potassium EDTA left on the needle that got into our red top, that can cause spurious hyperkalemia." |
| False WBC Count (nRBC interference) ANALYTICAL | Falsely elevated WBC count; bizarre differentials; nucleated RBCs counted as leukocytes | Post-splenectomy patients; chemotherapy (marrow endothelial damage); heat stroke; seizures; any condition releasing nucleated RBCs | Always make a blood smear; use nRBC correction formula: Corrected WBC = Observed WBC × [100 ÷ (nRBC + 100)]; inspect scatter plots for abnormal patterns | "I do not trust automated analyzers to very accurately confirm or deny the presence of nucleated red blood cells... make sure to do smear reviews for patients that are on chemotherapy." |
| False Monocytosis (Blasts) ANALYTICAL | Elevated monocyte count on automated differential; may mask leukemia | Circulating blast cells (lymphoid or myeloid) are misidentified as monocytes by analyzers; blasts don't behave normally with regards to RNA content or enzyme expression | ALWAYS question automated monocytosis >2,000; make blood film; look for large cells with immature chromatin and nucleoli; refer to clinical pathologist if suspicious | "I never trust a monocytosis from an automated analyzer ever... especially anything over two [thousand], I don't trust it." |
| False Monocytosis (Gray Eosinophils) ANALYTICAL | Monocytosis on automated count; actually eosinophilia when examined manually | Gray eosinophils (granules don't stain pink) misidentified as monocytes; common in Greyhounds (53%), Whippets, Golden Retrievers; also reported in cats | Recognize breed predisposition; blood smear shows cells with hyper-segmented nuclei but gray/vacuolated cytoplasm instead of typical monocyte appearance | "Gray eosinophils... are most commonly seen in greyhounds and whippets, but we do also see them in golden retrievers... automated analyzers can misidentify these cells." |
| False Elevated GGT PRE-ANALYTICAL | Markedly elevated GGT as sole abnormality; other liver enzymes normal | RBC contamination of serum sample (red cells contain GGT); poor pipetting technique; serum separator gel failure | Re-centrifuge sample and carefully remove serum; check for RBC pellet in stored serum; repeat on fresh sample if suspicious | "Red cells do have a little bit of GGT in them... We were not careful to remove the red cells... we need to inspect our sample." |
| Wrong Species Selection PRE-ANALYTICAL | Severe neutropenia with lymphocytosis; dramatic hematocrit discrepancy from PCV; bizarre differential | Clinician submits wrong species; lab selects wrong species on analyzer; running dog blood as cat or vice versa | Compare PCV to hematocrit (should be within 3%); look at cell morphology (dog eosinophils have round granules, cat eosinophils are rod-shaped); verify species with clinician | "If you run dog as cat blood or cat as dog blood, the hematocrit will be completely erroneous. So your PCV is going to be very different from your hematocrit." |
| Urine Contamination PRE-ANALYTICAL | Impossibly high values: BUN >500, creatinine >50, K+ >25; patient "shouldn't be alive" | Blood added to tube that previously held urine; urine very high in potassium, creatinine, and BUN | Use different colored tubes for urine (white-top) vs blood (red-top); smell sample if suspicious; results incompatible with life indicate contamination | "They actually contaminated the sample with urine... A BUN of 500, a creatinine of 57, a potassium of 26.2. He really shouldn't even be alive." |
| Catheter Draw Contamination PRE-ANALYTICAL | Unexpected hyperkalemia/hyperphosphatemia in supplemented patient; results inconsistent with i-STAT | IV fluids not adequately cleared from catheter line before blood draw; patient on K+ or phosphorus supplementation | Remove 3 mL blood before sampling from catheter; notify lab of catheter draws; compare to direct venipuncture if suspicious; avoid catheter draws when possible | "That day 3 a.m. sample was drawn through a catheter... and fluids were not adequately cleared from the line prior to the blood draw." |
| False Thrombocytopenia (Catheter) PRE-ANALYTICAL | Low platelet count with no clinical signs; no clots visible in tube; truly low estimate on smear | Clot formation in/around catheter that doesn't transfer to EDTA tube; platelets consumed by clot before reaching tube | Prefer direct venipuncture over catheter draws; correlate with clinical signs (bruising, petechiae); repeat with fresh direct draw if suspicious | "Clots are going to form because that plastic is sitting in the vessel... clots in your syringe do not always transfer into the EDTA tube." |
| Heparin Flush Interference PRE-ANALYTICAL | Coagulation test abnormalities; may affect other chemistry values | Heparinized saline flush not cleared before blood draw; heparin contamination of sample | Clear flush completely before drawing; remove adequate dead space volume; avoid catheter draws for coagulation testing | "If you've done a heparinized saline flush, if you haven't removed that and that heparin gets in the sample, it can cause all kinds of problems." |
| Alcohol Contamination PRE-ANALYTICAL | Complete hemolysis of sample; all RBCs lysed | Excessive alcohol applied to skin; not allowed to dry; alcohol drawn into syringe with blood | Allow alcohol to dry completely before venipuncture; don't over-saturate the area; if hemolysis occurs, redraw with proper technique | "If you are dousing your patient with alcohol and not letting it dry, if you suck enough alcohol into the syringe, it's going to lyse all of the red cells." |
| Expired Tubes PRE-ANALYTICAL | Unexpected results; possible bacterial contamination; seal failure | Rubber stopper seal dries out and cracks over time; allows environmental contamination while sitting in drawer | Check expiration dates on tubes regularly; rotate stock; discard expired tubes | "A lot of our tubes have expiration dates... the seal on the rubber stopper starts to dry out and crack... we've had bacterial contamination in our tubes." |
| Pediatric Reference Interval Error POST-ANALYTICAL | Flagged lymphocytosis in puppies/kittens; mild abnormalities that are actually age-appropriate | Using adult reference intervals for pediatric patients; many labs don't have pediatric-specific ranges | Know which values differ in young animals (lymphocytes higher, some proteins lower until 4-8 weeks); consult pediatric references; consider excitement response | "We at our university only provide adult reference intervals. We do not provide pediatric reference intervals... this patient actually does not have a lymphocytosis [when using pediatric ranges]." |
| Whipworm Pseudo-Addison's POST-ANALYTICAL | Hyperkalemia + hyponatremia mimicking Addison's; GI signs; young animal | Whipworm infection causes electrolyte disturbances resembling hypoadrenocorticism through unclear mechanism; NOT an error but commonly misdiagnosed | Consider age (5-month-old Addison's is unusual); do fecal exam; if suspicious, verify with ACTH stim test before treating for Addison's | "Whipworm infection can cause pseudo-Addison disease. It can cause hyperkalemia and hyponatremia for reasons that have not been fully elucidated." |
| Lipemia/Icterus/Hemolysis (LIH) ANALYTICAL | Flagged results; specific analytes affected; may cause false increases or decreases | Lipemia (unfasted patient, disease); icterus (hyperbilirubinemia); hemolysis (rough blood draw, in vivo hemolysis) | Fast patients when appropriate; note sample appearance; big labs will flag affected analytes; follow ASVCP quality assurance guidelines | "Common tested interferences are endogenous: bilirubin for icterus, lipid for lipemia, and hemoglobin... most big labs will release your results and flag something." |
| Sample Mix-Up / Mislabeling PRE-ANALYTICAL | Results completely inconsistent with patient's clinical condition or previous values | Wrong patient label on tube; lab transposition error; giving results to wrong client | Double-check labels at collection; verify patient identity; if results don't fit, consider sample mix-up before extensive workup | "I remember in practice, once I went over the wrong lab results with the wrong owner... diagnosing their cat with kidney disease when their cat was completely normal." |