Monday, December 15, 2014


A patient with CML presents with a WBC of 200,000. His vitals are stable. He is a little bit confused so you perform the maneuver shown above, then get a laboratory test. Unfortunately, your respiratory therapist forgets to put the sample on ice.

Challenge: What abnormality do you expect?

Image shown under Fair Use.


RaH said...

this is the Allen-test. it was designed to show the perfusion of the palm by the arteria ulnaris and radialis. it is executed before any arterial puncture in any of those arteries.
CML increases the thrombophilia, and infarction risk. it is possible that one of the arteries named above was affected by the disease.
i expect the inflammation parameters and clotting parameters to be elevated.

city said...

ABG in CML without ice probably gets you artificially low pO2 due to increased metabolism from the leuks

Craig Chen said...

yep! you guys are absolutely right

The image shows the Allen test which examines whether a patient has both radial and ulnar perfusion to the hand. The test is done before an arterial blood gas sampling to ensure collateral flow through the superficial palmar arch. ABGs should be put on ice and analyzed as soon as possible to reduce consumption by leukocytes. Leukocyte larceny can cause a factitiously low PaO2, especially if leukocytosis is profound.

Source: UpToDate.