Paper II — 2023 July (Supplementary) (2019 Scheme) — Q19
4 min read
Paper II
2023 July (Supplementary) (2019 Scheme) · 100 marks · 180 min
Question
A CSF sample was received in microbiology lab for culture. The label in the specimen
container was not matching with the specimen referral form. How will you manage the
situation.
Q191 marks
Answer
The correct decision is to reject the sample — given that CSF is an invasive, often irreplaceable specimen, and given the serious clinical implications of a mislabelled sample, the discrepancy between the specimen container and referral form must be resolved before any processing occurs.
Management:
Do not process the CSF sample while the identity discrepancy remains unresolved.
Immediately contact the requesting clinician/ward to clarify and, if necessary, confirm/correct the patient identity discrepancy — given the invasive and often irreplaceable nature of a CSF sample, every effort should first be made to resolve the discrepancy (e.g., confirming correct labelling was simply a clerical/paperwork error matching the correct sample) rather than automatically discarding it outright, unlike more easily re-collected specimens.
Document the discrepancy and the resolution steps taken as per the laboratory’s quality-assurance/incident-reporting protocol.
If the discrepancy cannot be satisfactorily resolved (i.e., genuine uncertainty about whose sample it is), the sample must be rejected, and, given the clinical urgency typically associated with a CSF request (suspected meningitis), the clinical team must be informed immediately so a repeat, correctly labelled lumbar puncture can be arranged without undue delay to patient care, and empirical antibiotic therapy should not be withheld pending this resolution.
