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Section 5 of 6 · Open sections

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Choose the next defensible action

A low platelet result with a platelet-clump flag and smear aggregates is unreliable, but it does not prove pseudothrombocytopenia or exclude true thrombocytopenia. A citrate factor of approximately 1.1 applies only to a correctly filled, locally validated sodium-citrate tube with no prior dilution correction; first confirm that the citrate smear is clump-free. Determine whether the analyzer or laboratory information system already applied a diluted-rerun correction before any factor is applied.

For short fill or extreme leukocytosis, follow the same fixed sequence: hold the order; review relationships and analyzer information; inspect the specimen and original smear; apply the validated intervention; and verify against observed evidence. Release only a verified result; otherwise recollect, suppress the affected result, consult, or escalate according to local policy.

The endpoint is selected by evidence rather than a presumed error: release a verified result, rerun a suitable specimen, use an alternate method, request recollection, or maintain suppression pending consultation or escalation.

Illustrative drawing — this picture was drawn rather than captured.

Workflow: hold order; review relationships and analyzer information; inspect specimen and original smear; use a validated action; verify evidence; then release or select recollection, suppression, consultation, or escalation.
Figure 1Required order from a held discordant result through review, inspection, intervention, verification, and release or escalation.

Ordering exercise

Put this platelet-clump investigation in the order that preserves evidence and keeps reporting bounded.

  1. 1. Use the validated alternate-anticoagulant pathway

    Collect and process an alternate tube only under local SOP.

  2. 2. Release or document unresolved escalation

    Release only a verified result; otherwise document suppression, recollection, consultation, or escalation.

  3. 3. Inspect specimen and original smear

    Confirm clumping and assess direct morphology before intervention.

  4. 4. Hold the discordant platelet result

    Prevent release before the discrepancy is resolved.

  5. 5. Verify against observed evidence

    Confirm the result and its endpoint before reporting.

  6. 6. Review relationships and analyzer information

    Use formulas, flags, and method-specific displays to localize the discrepancy.

Knowledge checks

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Knowledge check 1

For a WBC result beyond analyzer linearity, which safeguards must precede release? Select all that apply.

Choose at least 3 options.

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