Improper phlebotomy practice is among one of the most important, and more so, overlooked issues in laboratory medicine. Lab practices involving phlebotomy are critical for diagnostic purposes as erroneous results from incorrect collection can result in potentially life threatening misdiagnoses or treatment routes. This pre-analytical error can result in misleading hyperkalemia and hypocalcemia illustrated in otherwise healthy patients. Improper order of draw can incur costs for both the patient and healthcare facility. Preventative measures must be employed to reduce such adverse events from reoccurring as this singular error can lead to a domino effect of continuous error if not recognized and investigated.
A 67-year-old female presented with an abnormal complete blood count (CBC) when arriving for an angiogram. An abnormal white blood cell (WBC) differential showed 17% blasts which led her physician to have a bone marrow biopsy performed. The bone marrow aspirate smear showed an increased number of blasts and the bone marrow core biopsy revealed 90% cellularity where normal precursors were replaced by blasts. Flow cytometry and chromosome analysis results were consistent with Acute Myelomonocytic Leukemia (AMML). The patient was placed on FLAG chemotherapy until a goal of 0.9-1.0x10^9/L absolute neutrophil count is achieved, at which time a catheter will be placed to address her cardiac comorbidities. Cardiac disease and AML comorbidities are a commonly encountered issue in oncology patients. Due to this patient’s history of cardiac disease, treating her AML is more complicated in order to ensure that chemotherapy does not worsen her cardiac complications.