Here’s
a little something that came up whilst working in clinical chemistry a few days
ago. I found this set of results:
Specimen Results Entry
COBBLEPOT, Oswald A+ 20/11/2014 u/k MRS 23/11/1946 67 yrs F 123456 Arkham
Mr Vladimir Freeze
routine. Specimen No : AC619028V Selected Auth Level : S --------------------T-------------------T-------------------T------------------- NA 136 F000 |ALKP 98 F000 | | K 8.8 F000 |ALT 6 F000 | | KBIC 21 F008 |CRP 108 F000 | | U 13.7 F000 |HINT ^0.1 F000 | | CR 131 F000 |IINT ^6 F000 | | _GFR 35 F000C|LINT ^-0.0 F000 | | PROT 35 F000 | | | ALB 11 F000 | | | GLOB 24 F000 | | | TBIL 8 F000 | | | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD 1 Auth'd 2 Unauth'd 3 Nomin'd 4 Change 5 Reject 6 Options 7 eXit> U Disc: CLIN Sect: CC David Styles SRE/APEX Overtype |
That
potassium result is high; seriously high and most interestingly JNOT consistent
with previous findings
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham ------T-----------------------------------------------------------------------] Date|20/11/2014 19/11/2014 18/11/2014 17/11/2014 15/11/2014 14/11/2014 | Time|u/k u/k 16:50 u/k u/k 01:30 | Spec|AC619028V AC618219L AC617116S AC615563X AC614400T AC613165N | |BIO BIO BIO BIO BIO BIO | Test--+-----------------------------------------------------------------------{ NA |136 137 134 131 127 133 | K |8.8 3.9 4.5 4.9 4.8 5.0 | KBIC |21 | U |13.7 15.4 | CR |131 153 139 141 133 135 | _GFR |35 30 33 33 35 34 | PROT |35 | ALB |11 13 | GLOB |24 | TBIL |8 | ALKP |98 | ALT |6 | ------T-----------------------------------------------------------------------] 1 View 2 Graph 3 eXit X Cursor Down for more More >> |
There’s
something wrong here. That result’s not right. So a little detective work was
in order.
The
age of the sample was then checked. The sample was only an hour old.
The
nature of the sample was checked. The sample was a SST; not EDTA. An EDTA
sample would give a much higher potassium result, but it was something that
needed checking.
Perhaps
there was EDTA contamination, so calcium levels were analysed. Suspecting EDTA
contamination we might expect a very low calcium result.
The
result was 1.6... low, but not *THAT* low.
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham routine.
Specimen No
:
AC619028V
Selected Auth Level : S
--------------------T-------------------T-------------------T------------------- NA 136 F000 |ALKP 98 F000 | | K 8.8 F000 |ALT 6 F000 | | KBIC 21 F008 |CA 1.6 E000 | | U 13.7 F000 |$CORCA CALUNR E000 | | CR 131 F000 |CRP 108 F000 | | _GFR 35 F000C|HINT ^0.1 F000 | | PROT 35 F000 |IINT ^6 F000 | | ALB 11 F000 |LINT ^-0.0 F000 | | GLOB 24 F000 | | | TBIL 8 F000 | | | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,RKOD 1 Auth'd 2 Unauth'd 3 Nomin'd 4 Change 5 Reject 6 Options 7 eXit> U |
For
completeness the potassium assay was repeated on our other analyser. The result
was identical; a genuine result.
This was rather frustrating… the result was
suspect. but EDTA contamination should have given a far higher potassium result
and a far lower calcium result. Perhaps there was only a little EDTA
contamination in this case?
A comment was added to the result:
Note raised potassium ? due to EDTA contamination. Please send
repeat
sample for confirmation. Ward (staff nurse) telephoned. |
A
couple of days later I reviewed the case:
COBBLEPOT, Oswald
A+ 20/11/2014 u/k
MRS 23/11/1946 67 yrs F 123456 Arkham
NA |136 137 138 136 137 134
K |H 4.3 H 8.8 3.9 4.5
KBIC | 21
U |19.9 19.2 17.5 13.7
CR |185 162 151 131 153 139
_GFR |24 28 30 35 30 33
PROT |44 43 45 35
ALB |12 13 13 11
GLOB |32 30 32 24
TBIL |5 6 6 8
ALKP |112 121 114 98
ALT |11 9 7 6
|
Subsequent
results were not consistent with that spurious result. I wonder what happened there.
But
the bottom line here is that it’s not all about churning out numbers….
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