Question 1

At 03:40 a haematology technologist reaches a ward nurse to pass on a platelet count of 8 x 10⁹/L on an inpatient. Beyond the value itself, which set of details belongs in the laboratory record of that call?

Accepted Answer

Read-back confirmation, recipient, and time — A critical-value call is only complete when the receiver repeats the result back and the technologist confirms it. The record therefore has to show who received the value, the exact time it was passed on, and that a read-back took place. Without those three elements there is no evidence the information actually reached a person who could act on it.

Question 2

A haemoglobin of 71 g/L released two hours ago is traced to a specimen drawn from an arm carrying a running saline infusion. A properly collected repeat gives 104 g/L. How should the earlier entry be handled in the laboratory information system?

Accepted Answer

Keep the original visible, flag it as amended — An amended report must preserve what was originally released, because decisions may already have been made on it. The corrected value is added alongside the original, the record is flagged as amended, and the reason — dilution by intravenous fluid — is documented. Anyone who acted on the first haemoglobin also has to be notified directly that it has been superseded.

Question 3

While pulling a wedge film from an EDTA tube on the evening run, a technologist notices fine fibrin strands trailing from the spreader. The analyser count on that tube fell within the patient's usual range. What is the appropriate handling of that observation?

Accepted Answer

Enter a specimen-condition comment in the LIS — Fibrin means cells have been consumed into a clot, so counts may be falsely lowered even when they look unremarkable. The observation belongs in the permanent electronic record attached to that specimen, where the clinician and the next technologist can both see it. Documentation that lives on a notepad or in conversation disappears at the end of the shift.

Question 4

An automated platelet count of 78 x 10⁹/L triggers a film review. The film prepared from the EDTA tube shows platelets rosetting around neutrophils, and a citrated recollection counts 210 x 10⁹/L. What should the technologist document alongside the corrected count?

Accepted Answer

An EDTA-dependent in-vitro platelet artefact — Platelets adhering around neutrophils is satellitism, an in-vitro reaction to EDTA anticoagulant rather than a disease process. The record should state that the low EDTA count was an anticoagulant-dependent artefact and that the reported figure comes from a citrated specimen. Documenting it prevents the next technologist repeating the investigation and stops the patient being worked up for thrombocytopenia.

Question 5

A film from a two-year-old with a known haemoglobinopathy shows 25 nucleated red cells per 100 leucocytes. The analyser reported a leucocyte count of 15.0 x 10⁹/L. What leucocyte figure should be released?

Accepted Answer

12.0 x 10⁹/L, corrected for nucleated red cells — Impedance and most optical channels count nucleated red cells as leucocytes, so the raw figure is falsely raised. The correction is the uncorrected count multiplied by 100 and divided by 100 plus the nRBC per 100 leucocytes, giving 15.0 x 100 / 125 = 12.0 x 10⁹/L. The corrected value is what the clinician needs, with the nRBC finding reported separately.

Question 6

A haemoglobin of 108 g/L is generated on a six-month-old infant seen in a paediatric outpatient clinic. Against which interval should the laboratory report present that value?

Accepted Answer

A paediatric interval matched to the infant's age — Haemoglobin falls steeply after birth and reaches its physiological trough around two to three months before slowly recovering, so infant values must be read against age-banded intervals. Judged against a six-month paediatric interval, 108 g/L sits near the lower end rather than indicating the marked anaemia an adult interval would suggest. Reporting the wrong interval invites unnecessary investigation.

Question 7

Ten minutes before handover the pending list still carries a reticulocyte count ordered at noon. There is no result, and no matching tube can be found at the bench or in the fridge. What should the technologist do before leaving?

Accepted Answer

Trace the specimen and record its status — An unresolved pending item is an outstanding clinical question, so it has to be actively traced through accessioning, transport and storage rather than cleared away. Whatever the outcome, the status is documented and the requesting area is told so a fresh specimen can be arranged. Silently cancelling the order removes the only visible signal that something is still owed.

Question 8

A bleeding disorders clinic orders a specific factor assay that the site does not perform, so the separated citrated plasma must travel frozen to a reference centre in another province. Which information must accompany the referred specimen?

Accepted Answer

A referral record with collection date and time — The receiving centre must be able to judge whether the specimen is still fit for the assay, which depends on when it was collected, when it was separated and frozen, and how it travelled. A referral record carrying those details plus patient identifiers, clinical history and current therapy is what makes the result interpretable at the far end.

Question 9

The incoming technologist reviews the prothrombin time control chart from the shift just finished. The runs were accepted at the time and roughly 40 patient reports went out. Looking at the pattern shown, what is the appropriate first step?

Accepted Answer

Notify the supervisor and open an incident report — Four consecutive control values above the plus two standard deviation limit is a systematic shift that should have halted reporting. Because patient results were released under an out-of-control condition, the supervisor is told immediately and a written incident report is opened so the affected reports can be reviewed and, if needed, recalled and reissued.

Question 10

After a spin, a sealed centrifuge cup is found cracked with dried blood inside the bowl. The technologist decontaminates the rotor and takes the centrifuge out of service. What else does this event require?

Accepted Answer

File an occurrence report and tell the supervisor — A breached sealed cup is a potential aerosol exposure, which makes it a safety event and not merely an equipment fault. It has to be reported to the supervisor at once and captured in a written occurrence report so exposure follow-up, root cause review and any affected specimens can all be tracked. The maintenance log alone records the machine, not the risk.

Question 11

An outpatient's first ever complete blood count returns a leucocyte count of 42 x 10⁹/L with a haemoglobin of 88 g/L. The film shows the immature mononuclear population illustrated. What should the technologist do with the film?

Accepted Answer

Refer the film to the pathologist that shift — A first presentation with a markedly raised count and circulating immature mononuclear cells is a suspected new leukaemia, which is one of the classic triggers for same-shift referral. The technologist reports the morphology observed, telephones the finding, and sends the stained film to the pathologist or designated haematologist so confirmatory work can start without a day's delay.

Question 12

A woman who returned from Lagos five days earlier attends a walk-in centre with fever and rigors. Thin films are prepared and the technologist observes the appearance shown. Which action best meets the technologist's reporting obligation?

Accepted Answer

Phone the finding at once and refer for review — Parasites on a thin film from a febrile returning traveller are treated as a critical finding, because falciparum infection can deteriorate within hours. The technologist telephones the positive result immediately, documents the call, and refers the stained films onward for confirmation of species and parasitaemia by the designated reviewer.

Reporting and Communication

The written trail behind every released result

Recording what you saw, not only what you measured

Releasing outcomes a clinician can act on

Making sure nothing ordered is quietly lost

Passing a specimen on to the right person

Speaking up when quality or safety slips

Escalating a film that suggests a new diagnosis