Labs in my area will no longer draw a citrate tube to prevent platelet clumping, how to fix this?
Background : 59 yr old female with 30+ year history of RA, Felty's syndrome and platelet clumping (EDTA reaction).
I have clumped so aggressively that, for a period around 20-25 years ago when I had monthly draws due to methotrexate prescription, I was drawn sitting next to the centrifuge in the lab annex of the clinic to make sure the sample was readable.
Subsequent to that, I now get occasional draws 4-6 times a year. I have made a practice of letting the phlebotomist know that I clump and they need to draw a citrate (blue top) tube. Occasionally they would ignore the request and I would get the call that the platelet count clumped and needed to be redrawn. To avoid extra pokes (and because I am not an easy draw : rolling/ducking veins, butterfly needles needed, even ultra sound to set an IV for a procedure a few years ago), I tried to self advocate and insist on the blue top draw.
Around 3 years ago I started to get not just push back but utter refusal by the tech to draw the tube if it was not on the orders (and it NEVER was). My doctors couldn't find a code to even order it. Once incidence involved a call from a new doctor receiving the CBC results to tell me that my platelet count was dangerously low and I should go to the ER for a transfusion. After several hours there and 2 more draws by the ER staff (the second one with citrate tube) I was sent home with my perfectly normal range platelet count.
I have tried Quest and LabCorp.. neither will draw a blue top tube on request if it's not indicated on the orders nor do the phlebotomists seem to have any awareness of a specific protocol for EDTA clumping. The most recent visit(today) at LabCorp involved my PCP's nurse walking over with the order while I waited at the lab (they are in the same business complex) but there wasn't a code to order it and neither the lab nor the doctor can find one so the lab will not draw the test. I declined to get drawn if they couldn't run all the tests and the nurse went back to her office to see what she could find out.
She called me about 30 minutes later and they have found the test but are not allowed to order it. It seems it can only be ordered by certain entities for studies or special permissions with the lab. So basically my PCP can't order a test for me to be performed to get accurate results for BASIC bloodwork.
We are going to try another lab in the area that doesn't seem to restrict access to ordering a blue top citrate tube, so hopefully we have found a solution.
My reason for posting this is to find out if anyone in the profession has any insight on why this is happening, was there some post-covid shift in lab protocols (timing wise that's the only possible correlation I can find) and whether there is a procedure we should be following to get the care I need.