The Lab Did It
The laboratory is often blamed for things, the dog at day’s end that gets kicked. Judge and jury often work outside our doors and call to inform us of the sentence. “The lab did it!” in other words. We’re left like a Peanuts character sighing in exasperation.
For example, an office nurse called to tell me our result was wrong because we had reported a urine color as yellow. “That urine was orange!” Her tone seemed scornful.
“Let me see what I can find out, and I’ll call you back,” I promised.
I checked the report, the tape, and other reports for specimens received about that time. Everything seemed in order. I asked the evening tech who performed the test, and he grinned. “It was yellow. No doubt,” he said.
Rookie techs can be obsessed with urine color, distinguishing yellow from straw, light yellow, slightly yellow, dark yellow, amber, and other Crayola shades, but after decades of bench experience staring at more urines than one cares to admit “yellow” is easily identified. Hemoglobin ultimately breaks down to urochrome, an excreted substance that gives normal urine its unmistakable hue.
Orange color is distinctive and often artifactual. It can be caused by Pyridium, rifampin, laxatives, certain chemotherapy drugs, and other medications and ingested substances. In some cases, it can indicate a liver or bile duct problem. Here the question is “Why would the urine be orange?”
I called the nurse back and asked her. She denied medications, vitamins, liver disease, or cancer. “It was orange!” she insisted. “It looked like very, very dilute orange soda.”
Maybe it was. Patients with something to hide can do weird things.
But if it was really urine, there was no physiological reason for it to be orange, it was labeled properly, and it wasn’t mixed up with another patient in the lab, it was probably yellow. I left it to be resolved by recollection. Alas, there was no explaining our “incompetence” away. The lab did it again. * SIGH *
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