Erroneous blood work....anyone else?

[FriendofFerals]

So here's the story: Romeo (profile pic) is a 14 year old Maine Coon Mix with type II diabetes in remission (with wet food only diet), stage 2 CKD and holding that level for almost 3 years. He takes mirtazapine when he gets finicky about food since he is a dry food addict. He went from 19lbs to 12lbs just by switching to wet food when the diabetes hit.

Recently he'd been sneezing--like 7-8 times in a row. No watery eyes or nasal discharge, no fever. Then he was picking at his food so I gave him a crumb of mirtaz, then another when that didn't work. He was sleeping a lot, it seemed...Put him on the scale and he was 10.6lbs. Called the vet.

I have another elderly cat on Depo for allergies and asthma and he was also sneezing 7-8 times in a row frequently so I thought maybe a virus blew in on the wind or something. Both are indoor only cats.

The vet did a full CBC with kidney function and while it showed no signs of a virus or infection, I was really upset at the rest of the findings:

RBC 6.16 (low)
HTC: 25.41 (low)
MCH: 20.5 (high)
MCHC: 49.6 (high)
PLT: 118 (low)
ALT: 20 (low)
AMY: 1230 (high)
CRE: 2.5 (high)
TP: 8.4 (high)

I was frantically researching causes for high hemoglobin, low RBC, macrocytic anemia, possible liver toxicity, possible pancreatitis and/or kidney issues until 2AM last night.

The vet said to re-test in 48 hours "to make sure he isn't 'crashing'" which also freaked me out. Romeo "seemed" OK, just off his appetite a bit and a little more lethargic than usual. He played with the squirrel tail toy and still woke me up in the morning licking my face so he wasn't isolating and hiding or anything like when he was really sick with diabetes.

So I took him in today and asked for a fecal also to check for parasites on the off chance he somehow ate a roach carrying something that his Advantage II flea meds don't cover, thinking maybe that's the reason for the anemia? They did both tests "in house" and the vet came out to give me the results and said all of his levels were now (magically) normal.

??????

His explanation was something about "possible artifacts in the vial" or something like that. Seriously I just had a $500 heart attack this week with that first test, then today, and I've been a wreck thinking Romeo is on a sudden downhill slope with everything failing all at once. And then suddenly it's a false alarm, he just needs an anti-histamine for his sneezing and to keep up the mirtaz when he is too picky with the wet food.

Has anyone else ever had a completely inaccurate blood test at the vet? Now I'm not sure I believe this good test. I feel like I want to take him to another vet and spend another $500 I guess to verify....It's so frustrating!

 

[catapault]

Is your hair completely white? I'm just glad the end result is positive, rather than the reverse. But they messed up, what B.S. to suggest "possible artifacts in the vial"

 

[FriendofFerals]

Every white hair I have is from these three old boys, I can assure you. Nothing in life panics me more than one of them being sick. I can handle car emergencies, water main breaks, hurricanes, and whatever else but not my cats being seriously ill.

I know everything's OK but my adrenaline spiked and now dropped and the post-emergency anxiety is hitting hard. I'm trying to just calm down and breathe but the last three days have been awful. I've had real emergencies with these three cats from glucose 450+ diabetes, constipation needing an enema, swallowing foreign objects, severe asthma attacks needing emergency vets, whipworms, allergies to flea meds, falling over and dragging their hind legs in a blood clot scare ($750 later after a cardiologist ultrasound it was found to be a severe inner ear infection causing vertigo....) so when something like this happens I go into Momma cat battle mode.

I thought those vials were sterile and single use? What kind of BS is that explanation of "artifacts in the vial?". That implies it might have been contaminated with another sample, right? And I'm paying all that money for that??

 

[fionasmom]

"Artifacts in the vial" means that one or several of a very large number of variables went wrong. These can range from human error like not labeling correctly, not using the correct vial, not shaking or shaking the tube, not storing it properly or storing at the wrong temp. Sometimes red blood cells, for example, can be damaged and if this is not caught before the test is run, it will cause an incorrect reading. I am hoping that your vet did not actually reuse vials, or contaminate from another sample, but however it happened you did not deserve to be put through all this worry and stress.

 

[Jabzilla]

Wow, I'm glad those results ended up being wrong! I've gotten incorrect results for one of my cats blood tests before as well. His platelets have a tendency to stick together and a test he got earlier in the year had results that shocked and flabbergasted both the vet and the person who does the testing itself. His results said he had a grand total of 5 platelets. The vet called me, distraught, saying my cat's bones had stopped creating fresh blood and that he had an immediate and serious problem, despite not having any symptoms of such an issue. Thankfully, that was shortly before being seen by a specialist. The specialist ordered another blood test and the results were fine. It turns out his platelets stuck together during a procurement issue, and he does indeed have more than 5 of them.

 

[FriendofFerals]

"Artifacts in the vial" means that one or several of a very large number of variables went wrong. These can range from human error like not labeling correctly, not using the correct vial, not shaking or shaking the tube, not storing it properly or storing at the wrong temp. Sometimes red blood cells, for example, can be damaged and if this is not caught before the test is run, it will cause an incorrect reading. I am hoping that your vet did not actually reuse vials, or contaminate from another sample, but however it happened you did not deserve to be put through all this worry and stress.

Thank you for the explanation. The vet was talking so fast I couldn't follow what they meant and I was just glad Romeo's blood work was OK. I did notice that they only charged me for the fecal test on the second visit (it came back negative for parasites today) so I guess they did quietly admit they messed up by not charging me. Still--how upsetting to know this can happen. This was at a "big name chain" or vets and the only reason I use them is because I can sneak over there on a lunch break for small stuff without taking half a day off of work. But after this, I'm considering changing vets completely.

 

[cmshap]

how upsetting to know this can happen. This was at a "big name chain" or vets and the only reason I use them is because I can sneak over there on a lunch break for small stuff without taking half a day off of work. But after this, I'm considering changing vets completely.

I was just reading this story. I would indeed be crazy-upset myself.

I would personally start by being vocal about what went wrong, and that I want assurance it won't happen again. That in and of itself doesn't bring you any assurance for next time, but you can gauge the reaction of the management.

Even with a big chain, there are local managers you can hold responsible and just get some ideas of how much they want to help (or ignore) you when you vocalize your complaint.

Human error is possible from all of us -- and I've actually experienced error with medical tests on myself in the past. I changed a doctor because of it, as there seemed to be no care or accountability for the error.

Anyway, those are my two cents on the matter. I'd bring it up, ask questions about why it was possible that it occurred, what assurances would I get that it won't happen again, and judge the response I get .

 

[fionasmom]

His results said he had a grand total of 5 platelets.

This is shocking as the idea of platelets sticking together should be well known to any vet; lots of people here on TCS have even mentioned that it can happen.

 

[Jabzilla]

This is shocking as the idea of platelets sticking together should be well known to any vet; lots of people here on TCS have even mentioned that it can happen.

Right???? You'd think that since the person doing the blood test was flabbergasted by those results, plus the tendency for feline platelets to clump together, plus the vet also being astonished would all add up to the results being an error. Rather than going with hurriedly calling me in a panic telling me that my cat is suddenly seriously ill and no longer producing fresh blood.

 

[silent meowlook]

Was this blood work run in house? Sounds like maybe they clotted their purple top which is the tube that the CBC in run off of. It is not surprising for a cat with kidney disease to be anemic.

The chemistry, Creatnine, Amylase, Total protein would have been run on serum. If the serum is hemolyzed, such as the blood cells damaged by a poor stick, or improper handling, it can alter some test results, although I have never seen the Creatnine altered by this.
If this blood was sent to a lab, the lab should and will, if asked, eat the cost of the wrong test.
If done in house the hospital should eat the cost.
Also, it is possible that the wrong blood went into the wrong bag. Inexcusable mistake as far as I am concerned, but it does happen.

 

[FriendofFerals]

Was this blood work run in house? Sounds like maybe they clotted their purple top which is the tube that the CBC in run off of. It is not surprising for a cat with kidney disease to be anemic.

The chemistry, Creatnine, Amylase, Total protein would have been run on serum. If the serum is hemolyzed, such as the blood cells damaged by a poor stick, or improper handling, it can alter some test results, although I have never seen the Creatnine altered by this.
If this blood was sent to a lab, the lab should and will, if asked, eat the cost of the wrong test.
If done in house the hospital should eat the cost.
Also, it is possible that the wrong blood went into the wrong bag. Inexcusable mistake as far as I am concerned, but it does happen.

It was done "in house". All of the values including creatinine came back normal (or in the case of creatinine, only slightly elevated which is consistent with his Feb 2023 test). All the other values that were way high or low came back "perfect" the second time. So basically he was sneezing from an allergy or something and off his food because of feeling off from that, but no virus or infection according to the WBC on both tests. So he needed an antihistamine and wasn't actually dying. The clinic did eat the cost of the RBC re-test (quoted $92), but not the erroneous comprehensive one ($430).

 

[silent meowlook]

It was done "in house". All of the values including creatinine came back normal (or in the case of creatinine, only slightly elevated which is consistent with his Feb 2023 test). All the other values that were way high or low came back "perfect" the second time. So basically he was sneezing from an allergy or something and off his food because of feeling off from that, but no virus or infection according to the WBC on both tests. So he needed an antihistamine and wasn't actually dying. The clinic did eat the cost of the RBC re-test (quoted $92), but not the erroneous comprehensive one ($430).

That is unfair to you and your cat. That is such a large amount of money for you to have paid for absolutely nothing but stress.

In house lab work is run by veterinary assistants and technicians. Some of whom know what they are doing and some don’t. Some care, some don’t. Some will immediately come foward if they have made a mistake and some won’t. The equipment is good but maintenance must be done on the machines and software needs regular updating. Quality control should also be checked.
As a client, there is no way of knowing if all of this is being done. So, there is a kind of blind faith we must have in that it is.
The veterinary labs are staffed with people whose only job is to do labs. So, there is no, half way through the test and have to do an emergency nail trim. Therefore the laboratory is best to send blood, unless you need immediate results.
I do both on my cat. Often it is more convenient to just have the vet run the blood so you know right away what is going on.

I would very nicely discuss why you had to pay for results that were either, not your cats, or had a technical error.

if you can get a copy of the labs it will show on the bottom of the page if there was a sample error.
Obviously if you are ok with it that’s great. But, for me that is allot of money to be wasted.

 

[LeiLatte]

I did not have a wonky blood test, but we did a felv/fiv test and later they told me the tech “made an error” and had to redo the test (after they already gave my cat the felv vaccine without checking results first!). So I took her home and later the vet called saying she was positive for heartworm. So he wanted to double check and I had to pay for another test but they ran out of the rapid snap test, so they had to send it to the lab (and this clinic charges over $100 for each test). They let me redo the first test free since they made a mistake, but I still had to pay for the initial test and the “double check” lab test. I do not trust this specific doctor (he is new to that clinic) and I thought something seemed fishy.

 

[silent meowlook]

With the heart worm test, the snap test, which is the FELV/FIV/HWT, in house, the heart worm is not accurate for cats I have been told. You need to send out to the lab for the specific heart worm test. I had to do that with my cat. Did your cat wind up being positive on the test to the lab?

 

[FriendofFerals]

With the heart worm test, the snap test, which is the FELV/FIV/HWT, in house, the heart worm is not accurate for cats I have been told. You need to send out to the lab for the specific heart worm test. I had to do that with my cat. Did your cat wind up being positive on the test to the lab?

They only did a fecal test for parasites (clean). He doesn't have heartworms though, and his flea medication covers that. It's been a week, his appetite is still off, seems nauseous so giving him what's left of the Cerenia I have...he ate a little today on his own but we had another bad syringe feeding session this morning followed by a bath after he flung it everywhere. Diarrhea the morning...Monday I take him to a new vet, bringing all the "lab work" we just did.