​A 15-year-old white girl presented with headaches and night sweats of 2 weeks' duration. Her platelet count was 50 × 103/μL (50 × 109/L) [reference interval, 140–440 × 103/μL (140–440 × 109/L)]. Upon referral to hematology/oncology, the patient had a leukocyte count of 21 × 103/μL (21 × 109/L) [reference interval, 3.8–9.8 × 103/μL (3.8–9.8 × 109/L)] with 46% lymphoblasts. The patient was diagnosed with pre-B acute lymphocytic leukemia and was started on treatment. A follow-up sample for a basic metabolic panel that had been drawn into lithium heparin and centrifuged is shown in Fig. 1

Fig. 1. Appearance of a blood sample obtained for a basic metabolic panel after it had been drawn into lithium heparin and centrifuged.


QUESTIONS

  1. Why are data from this type of sample compromised?
  2. What is the most likely reason for the appearance of this sample?
  3. What are potential remedies to extract meaningful data from this sample?