Blood Taking Manual

Recalling the days in govt hospital - especially during those housemanship years - many, if not all, doctors find it difficult and confusing whenever it comes to blood taking. The red plain tubes, purple EDTA bottles, orange, yellow, grey, etc... and some with gel in them, some without. In the fridge, there will be those for PT/INR, special viral transport medium (VTM) tubes etc. The list just goes on.

And after the tedious blood taking session - we at times find the returned "investigation forms" written with red ink: "sample tak cukup" (inadequate blood sample) or the worst of all "salah tubing" (wrong tubes)!! WTF!! We have to repeat taking the blood (sometimes at 3am), and apologizing to the patients who sneer at us...

I just wonder how come the hospital lab just cannot produce a standardised "Blood Taking Manual" like those given to those private GP clinics for free (from PathLab, BP Lab and Gribbles) - for the sake of those newbies (housemen) or even for some senior doctors who are unsure which tubes we should place the blood in.

For instance, if we would to ask the houseman to take a sample for "septic workup" or "febrile study" - what do we mean actually? And how many bottles and what types of tubings are needed? Most often than not the houseman will stare in blank and ask his colleagues who are more senior "so what tubes to use ah?" or "how many mls of blood needed ah?"... Many of a time, CRP is missed, ESR not sent, or ordering FBC instead of including PBF... Then the specialists get mad, the MO stuck in between, and the poor new HO is stressed up!

Another example is when the MO orders the new HO to "screen this patient for thalassemia" or the commoner one like "do an iron study on her" - so what's next? What are the blood to take? How many mls each tubing? Send to which lab?

If all this can be cut short by just flipping through the standardised manual given by the lab, imagine how much time we can save and reduce errors like wrong tubings, inadequate blood sample or even mistake like having short of one plain tube sample (having sent only 1 plain tube instead of two, because we thought they are all done in the same lab)...

Then the manual should also include profile samplings like eg. Dengue fever study, Diabetic study, Down syndrome (triple test) etc. And each of those profile includes the list of breakdown of blood or urine needed, and the specimen requirements (eg 4ml FLUORIDE tube, 10ml PLAIN tube, 50ml first void morning urine sample) - and then specify which lab they should be sent to (eg. Biochem, Pathology, Microbiology).

Please don't assume that every single doctor knows this, although after working for a few years, they seem like bread and butter.

For me, SOP should be implemented day in day out, and not assuming things in the ward. Because if we "assume" - we are creating an "ass" out of "u" and "me"!