Laboratory Professionals Member Community

Original Message:
Sent: 12/28/2024 1:47:00 AM
From: Laterra Slate
Subject: RE: Clotted cbcs

The guidelines have not changed. You should definitely document the increased clotted samples. Bring the attention to supervisors to address why the techs are accepting clotted samples. To relook at what is acceptable and what is not . Why a redraw maybe necessary.

Hi Maurine,

No CBC should be accepted if the sample is completely clotted. However, under certain circumstances (like neonatal dermal collections or extremely difficult collections), a sample might be accepted with a microclot or platelet clumping. The micro clots can be removed with wood sticks and platelet clumps partially resolved with vortexing. Results would need to be reported with the proper precautions and warnings, of course, if a more adequate specimen cannot be obtained. 
Cord blood CBC's are almost always clotted. 

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James Williams PhD., MLS (AMT), MLT (ASCP)
San Antonio TX
(210)646-7047
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I’m a Cytotech, so I can’t provide you an answer for accepting clotted specimens, but what I can reply to, is the ever increasing and disturbing lack of quality leadership in the Laboratory field. The lack of properly trained leadership is the catalyst for this poor behavior.

I am a newer tech graduated 2022. My lab always rejects clotted cbc’s. 1. Your results will be inaccurate. 2. Could mess up your analyzer.
Sent from my iPhone


Original Message:
Sent: 12/28/2024 9:44:00 AM
From: Carl Benkoski
Subject: RE: Clotted cbcs

I’m a Cytotech, so I can’t provide you an answer for accepting clotted specimens, but what I can reply to, is the ever increasing and disturbing lack of quality leadership in the Laboratory field. The lack of properly trained leadership is the catalyst for this poor behavior.

Clotted CBC’s are invalid specimens… I started in pediatrics in 1982- it was not fun to tear apart analyzer for clot so small the eyes missed- there’s a reason they are ordering CBC- integrity begins with sample collection-

Sent from my iPhone 😊


Original Message:
Sent: 12/29/2024 12:52:00 AM
From: Pamela Bennett
Subject: RE: Clotted cbcs

I am a newer tech graduated 2022. My lab always rejects clotted cbc’s. 1. Your results will be inaccurate. 2. Could mess up your analyzer.
Sent from my iPhone

Juliana brought up another good point.  I have seen issues with a clot causing problems with the next specimen rate.  I'll give an example.  Phlebotomist comes from the nursery with EDTA Ped tube for a CBC to be ran.  Tech runs the CBC, the analyzer detects platelet clumps.  Tech looks at specimen, checks it by running a stick through it and then rejects it after observing a clot on the stick.  Then, a different patient sample for a CBC is placed on the analyzer.  The analyzer then has a sampling error without several values either way off or without any value.  Morale of the story... Always flush the tubing after a these samples go through the analyzer!  I believe a lot of analyzers have an option under maintenance specifically to "purge" the tubing.  Then always make sure to perform a background check.  I've seen instances where you purge the tubing and the background check fails, so you do it again and then check another background check.  This would be a good Quality Assurance implementation for the Hematology Department.  Get a procedure in place.  If you have a lot of pediatric or high volume nursery specimens, I personally think it saves a lot of grief to do this proactively after you run one those microtainers through.  Maybe, you see a nursery draw and just gently remind the new tech in Hematology that day.  Explain why you do it.  I remember making mistakes as a new tech and there was one senior tech that would say, "I bet you won't do that again!"  It took me a while to realize what she meant until I was on call and had to troubleshoot something because of a silly mistake I made.

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Jason Hamilton
Superior NE
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Original Message:
Sent: 12-30-2024 04:33
From: Juliana Hultstrom
Subject: Clotted cbcs

Clotted CBC's are invalid specimens… I started in pediatrics in 1982- it was not fun to tear apart analyzer for clot so small the eyes missed- there's a reason they are ordering CBC- integrity begins with sample collection-

Sent from my iPhone 😊



Original Message:
Sent: 12/29/2024 12:52:00 AM
From: Pamela Bennett
Subject: RE: Clotted cbcs

I am a newer tech graduated 2022. My lab always rejects clotted cbc's. 1. Your results will be inaccurate. 2. Could mess up your analyzer.
Sent from my iPhone



Original Message:
Sent: 12/28/2024 9:44:00 AM
From: Carl Benkoski
Subject: RE: Clotted cbcs

I'm a Cytotech, so I can't provide you an answer for accepting clotted specimens, but what I can reply to, is the ever increasing and disturbing lack of quality leadership in the Laboratory field. The lack of properly trained leadership is the catalyst for this poor behavior.

When you say accepting, do you mean they actually run the CBC? I can't image anyone running the CBC and reporting results as accurate. There should be a SOP for this process, and maybe the newer techs need to be instructed the proper way to handle and report the issues.

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Andrea Gordon Educator (academic)
Plainfield NH
(603)359-7053
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Oh, I’m positive there is an SOP for specimen handling. But, if as you stated, wondering about the acceptance of these specimens, than I put the blame squarely on the lab leadership, or lack thereof.


Original Message:
Sent: 12/28/2024 9:52:00 AM
From: Andrea Gordon
Subject: RE: Clotted cbcs

When you say accepting, do you mean they actually run the CBC? I can't image anyone running the CBC and reporting results as accurate. There should be a SOP for this process, and maybe the newer techs need to be instructed the proper way to handle and report the issues.

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Andrea Gordon Educator (academic)
Plainfield NH
(603)359-7053
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Original Message:
Sent: 12/28/2024 10:09:00 AM
From: Carl Benkoski
Subject: RE: Clotted cbcs

Oh, I’m positive there is an SOP for specimen handling. But, if as you stated, wondering about the acceptance of these specimens, than I put the blame squarely on the lab leadership, or lack thereof.

CBT’s have limitations. How many CBT’s has anyone ever done that all they want to do is get through them as fast as possible to be done!
The requirement for a leadership position should be a defined amount of face-to-face education credits. The way the laboratory picks its leadership is abysmal. Far too many are chosen from within and have little to no mentorship. That goes for those from Leads to CEO’s!


Original Message:
Sent: 12/28/2024 11:39:00 AM
From: Maureen O'Brien
Subject: RE: Clotted cbcs

Thank you all so much for your responses. 

I agree, leadership  certainly plays a factor but what about the online programs that are teaching this?

  - Mo��

Maureen O'Brien

PO Box 663

New Castle, CO 81647

Original Message:
Sent: 12/28/2024 10:09:00 AM
From: Carl Benkoski
Subject: RE: Clotted cbcs

Oh, I’m positive there is an SOP for specimen handling. But, if as you stated, wondering about the acceptance of these specimens, than I put the blame squarely on the lab leadership, or lack thereof.

Original Message:
Sent: 12/28/2024 11:39:00 AM
From: Maureen O'Brien
Subject: RE: Clotted cbcs

Thank you all so much for your responses. 

I agree, leadership  certainly plays a factor but what about the online programs that are teaching this?

  - Mo��

Maureen O'Brien

PO Box 663

New Castle, CO 81647

Original Message:
Sent: 12/28/2024 10:09:00 AM
From: Carl Benkoski
Subject: RE: Clotted cbcs

Oh, I’m positive there is an SOP for specimen handling. But, if as you stated, wondering about the acceptance of these specimens, than I put the blame squarely on the lab leadership, or lack thereof.

I agree that you should have a procedure specific to your laboratory as to how to handle "clotted" specimens.  I would also question whether the specimen was being mixed properly upon collection.  I've seen Phlebotomists give an EDTA sample one quick inversion and reminded them that the tubes should be inverted several times.  That leads me to another question.  I'd be curious to know if these samples are macroscopically or microscopically "clotted".  In my experience, I've observed the microscopically clotted specimens are simply inadequate mixing by the collection technician or possibly traumatic/ difficult draws.  Usually the instrument might say something like "Platelet Clumping".  Then I'd review the slide and many times I might see "sticky platelets".  I'd also mix the specimen really well and rerun the specimen manually through the instrument.  If the platelet count was similar, I'd always look at a delta check and see if this was reasonably close to previous counts.  If the platelet count was statistically similar to previous counts and I saw "sticky platelets" I would note that on the report.  It could be a problem with the patient intrinsically.  (These are cases where macroscopically there was no specimen clumping.  We'd run a stick through to make sure there wasn't any visible clumps.)  I would also question whether instruments were as sensitive 20-30 years ago compared to today.  Could instruments from years ago detect these microscopic platelet clumps or would the instruments just report a higher MPV instead?  So, I would agree that it comes back to what are the acceptable standards for a facility and what is the criteria for accepting or rejecting these specimens.

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Jason Hamilton
Superior NE
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Original Message:
Sent: 12/29/2024 11:24:00 PM
From: Roberta Mazourek
Subject: RE: Clotted cbcs

I have 2 new grads and they just don't think. One thought if she put a frozen calibrator in the water bath for 30 minutes it would be ok. Clotted samples are run on the automated lines all the time. A flag should populate but not always and they accept the results. If you see this then bring it to the supervisor's attention. We are having more and more issues with the new grads not caring or even bothering to do the job right.