Our December, 2018 Quick Question on specimen integrity drew 46 responses. The question was, “How do you manage a plasma that appears to have fibrin strands?” Here are the answers:
a. Reject and request a redraw: 41 (89%)
b. Perform requested assay and report if non-critical: 1 (2%)
c. Perform factor assays to confirm specimen integrity: 1 (2%)
d. Other: please provide a written response: 3 (7%)
We received a written comment from Robyn Coleman, which appears in the original question. It appears that most of us, like Robyn, are inclined towards caution, even when test results seem non-critical, perhaps on the principle that the non-critical results could have been clinically important had the specimen been valid.
This result illustrates the need for good specimen management particularly as it relates to hemostasis test results. I (Geo) suspect this is more easily accomplished in a local facility than in a reference laboratory that receives thousands of specimens a day with little information about how the specimen was originally collected, stored, and shipped. I’m curious about how reference laboratories assess specimens for validity in a high-volume situation.