The Unlabeled Specimen
You are working in a busy outpatient laboratory. A phlebotomist, Sarah, has just drawn blood from a 45-year-old male for a CBC and comprehensive metabolic panel. She places the two tubes in a rack and moves to the next patient. You notice that one of the tubes (the lavender-top EDTA tube) has no label. Sarah is across the room and says, 'I'll label it in a minute, I know whose it is.' The tube has been sitting at room temperature for 10 minutes. The patient is still in the waiting area.
1. What is the correct action regarding the unlabeled tube?
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The unlabeled tube must be discarded and a new specimen must be collected. According to standard laboratory accreditation requirements (e.g., CLSI, CAP), specimens must be labeled at the time of collection in the presence of the patient. An unlabeled tube cannot be reliably identified, and labeling it after the fact introduces a risk of misidentification. Even if Sarah believes she knows whose tube it is, the tube is not labeled and therefore cannot be accepted for testing. The correct action is to discard the tube, explain to the patient that a small additional sample is needed, and recollect the lavender-top tube, labeling it immediately at the bedside.
2. What are the implications for patient safety and laboratory policy?
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Patient safety: Misidentification can lead to wrong results, incorrect diagnosis, or inappropriate treatment. For example, a mislabeled CBC could result in a patient receiving unnecessary transfusion or having a missed anemia diagnosis. Laboratory policy: Most laboratories have a strict 'no label, no test' policy. Labeling must occur at the time of collection, with two patient identifiers (e.g., name and date of birth) verified against the requisition. The phlebotomist should be counseled on the importance of immediate labeling. The incident should be documented as a quality event. The patient should be informed and a new sample collected with proper labeling.