title: Abnormal gel flotation in a patient with apperant pneumonia diagnosis: a case report.
abstract: BACKGROUND
  Serum blood collection tubes with separator gel are widely used by many laboratories for chemistry analyses. We describe a case of a primary blood collection tube filled with blood sample and a floating separator gel.
  
  
  METHODS
  The blood sample was collected from a 51 years old female in intensive care unit with the diagnosis of pneumonia into a BD Vacutainer SST tube (Becton Dickinson, NJ, USA) containing serum separator gel and conveyed to the core laboratory of Marmara University Hospital within 30 minutes from collection. Sample was immediately centrifuged at room temperature at 1500 × g for 10 minutes.
  
  
  RESULTS
  The analyses revealed a highly increased total protein concentration of 145 g/L (reference interval 64-83 g/L). The nephelometric analyses showed an elevated serum IgG concentration of 108 g/L (reference interval 6.5-16 g/L) and IgG lambda monoclonal band was determined by serum immunofixation electrophoresis.
  
  
  CONCLUSIONS
  Limitation of the separator gel tubes in patients with a high plasma density and its possible effects on test results and laboratory costs should be remembered. The clinical diagnosis stated in the information system should also reveal known comorbid conditions besides the apparent admission reason. This information would avoid resampling, additional testing, and communication efforts with the clinicians.
authors.affiliation: Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Fethullah
authors.initials: F
authors.lastname: Gerin
authors.affiliation: Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Dilber Coban
authors.initials: DC
authors.lastname: Ramazan
authors.affiliation: Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Baykan
authors.affiliation: Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Onder
authors.initials: O
authors.lastname: Sirikci
authors.affiliation: Department of Biochemistry, School of Medicine, Marmara University, Istanbul, Turkey.
authors.forename: Goncagul
authors.initials: G
authors.lastname: Haklar
mesh_terms: D001798:Blood Proteins / Q000032:analysis*; D001800:Blood Specimen Collection / Q000295:instrumentation / Q000379:methods*; D003951:Diagnostic Errors; D005260:Female; D005782:Gels; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D013048:Specimen Handling / Q000295:instrumentation / Q000379:methods*
chemical_list: D001798:Blood Proteins; D005782:Gels; D007074:Immunoglobulin G
keywords: blood collection tube; floating gel; hyperproteinemia; preanalytical phase; separator gel