“KEEP IT WARM” Blood Draw & Lab Technique

CADs that have become more Reactive to cold Temperatures than a normal person.  Often progress into needing a special blood test method of collection and Lab cooperation.

See in depth information on Blood Draw Problems and Techniques

The Standard Protocol for CBC/RBC Tests may start failing often, or fail all the time.  It has to do with the Agglutination/Clumping of Red Blood Cells when the blood is removed from body temperature.

Most other routine blood tests will result just fine.

Initially the patient may experience hit and miss CBC/RBC tests that fail or are inaccurate.  Where you as a patient have to give another sample and they test again.  You may not suspect what is going on yet.  Not tie it to the possibility you are becoming more cold sensitive.

Your Dr may not even be aware, let alone the blood facility techs or Lab personnel, you are being tested through.  The lab/techs may not even start catching on after they are aware test after test fails and they keep coming back for another sample/blood draw.

This is a common problem that numerous CADs have experienced over and over.

If you are getting resistance from a phlebotomist listening to you.  It is time to  bump this up to the lab manager/administrator.  It is best to be armed with documentation from your Hematologist.   Or know various places to refer the lab personnel to read the information.

This is also encountered often with Emergency Room personnel, techs, nurses, PA’s and doctors.

If you have moved into this group of CADs.  The CBC/RBC blood specimen will start requiring special handling to produce consistent, accurate test results.

CADs, in this scenario,  may eventually require a “Keep it Warm” process performed all the time for a CBC/RBC.  By the way.  This is not an official medical term.  While it is well known amongst CAD support groups, CAD Social Media groups,and CAD literate Hematologists.  Most  phlebotomists will have not clue.  Unless they have run into CAD patients in the past.

In the “Keep it Warm” process.  The specimen tubes must be pre-warmed, the drawn specimen kept warm, and the lab testing done stat.   So that person back in the lab needs to be on board too.  Ideally the sample needs to maintain  body temperature 98.6°F/37°C.   Remember this does not apply to most routine blood tests.  It does for a CBC/RBC.

If your are in this stage and that sample sits back on the counter in the lab, it will not result correctly.

Reheating the specimen as labs will often tell you initially.   May, or may not, work.  Not if the CAD is in this stage.  Its all BS due to the fact they are not informed.

Some facilities use a non-standard protocol to result a Cold Agglutinin Disease affected CBC/RBC.   But it is difficult to find a facility the will accommodate you.  Go to link that discusses alternate blood draw techniques and specifically “Plasma Replacement Technique”.

Getting a facility to do the Plasma Replacement is most likely going the be at a facility your insurance won’t initially approve.  That becomes another hurdle to fight and solve.  It most likely will require involvement by your doctor, and personal contact by you with your insurance carrier supervisors.  But you should be able to make it happen?

Your particular Medical Care Providers, Phlebotomist, and or lab, may or may not be up to speed on any of these CAD related issues.  Your lab/tech contacts may have been doing their job for years or decades.  They may have never been confronted with this.  You can imagine their disbelief.  Or their resistance to listening to you.

Satellite specimen collection where the sample is later shipped to a lab, reheated at the lab later, may not successfully result for the CBC/RBC.  It may do just fine with many of the other routine blood tests.

Repeating; “keep it warm” is another CAD Patient made up term used by many CADs.  But to our knowledge it is certainly not an official medical term.  So if you start throwing that term around at a blood testing facility or ER room, you might encounter a blank stare.   You will  have to explain.  Expect to be met with doubt.  Having written documents explaining this, will become most helpful.

This “Keep it Warm” technique will often be talked about or recommended on CAD type of social media or support forums.  Perhaps your doctor will  know enough to advise you?  If they are familiar with CAD, they will most likely explain this to you.

Once you are in this scenario.  It’s best to have written and signed documentation (By your Dr on their letterhead) detailing the steps to the “keep it warm” technique.  Carry this with you to present at any blood facility, ER Room etc.  Believe me, it will prove invaluable to you.  It will prevent lots of conflicts or even being disbelieved, looked at as a problem person, etc.  Ultimately the goal is, it will eliminate multiple arm poking for re-doing the test.  To also get you an accurate result.

When this Keep it Warm process is not followed on the CADs at this cold sensitivity level, the CBC/RBC will often fail to result, or have invalid numbers.

Note:  Often patients newly identified as having CAD, are already in this stage.

There is even a more rare group of CADs that are so cold sensitive.  Their agglutination is so intense.  Even “Keep it Warm”, or reheating the specimen fails to result or properly result a CBC/RBC.  Out of 500+ CADs we are in contact with.  Only two have had to deal with yet another approach.  Convincing a facility to do it.  Quite frankly is nearly impossible if you don’t have a doctor step up, and go to bat for you.  Even then your better have a persistent streak in you!  See: Go to link that discusses alternate blood draw techniques and specifically “Plasma Replacement Technique”.

Some CADs may never have had any previous health symptoms to trigger any type of blood testing, when they were healthy, and not troubled by CAD.

 772 total views,  2 views today