A challenging laboratory case due to inappropriate sampling through an antiseptic barrier cap

Antiseptic barrier caps are currently used as novel tools in critically ill patients to achieve sterility of the blood sampling site and to prevent central line-associated bloodstream infections in the intensive care unit. A clinical and laboratory case of analytical interferences on erythrocytes, platelets and leukocytes due to the isopropyl alcohol contained in the antiseptic barrier cap is described. An aged man with history of heart valve disease was monitored for hematological parameters after surgery of mitral and tricuspid valve replacement. Leukocyte scattergrams changes on the Sysmex XN 2000 analyzer with the suspicion of platelet clumps were observed. After investigation on sampling procedure, antiseptic barrier cap of an arterial access (BD PureHub disinfecting cap) was used. Another sample has been requested, and the analysis of complete blood count and peripheral blood smear confirmed the presence of clumped microerythrocytes and erythrocytes with damaged membranes. In addition, differential leukocyte count revealed an overestimation of eosinophils by 10%. A new sample taken from venous access provided accurate results without alterations. The preanalytical error generated during blood sampling highlights the importance of correct use of biomedical devices. Furthermore, hematology analyzer technology represents a promising tool for assessing sample quality.