Underfilled blood collection tubes as pathologizing factor for measured laboratory parameters in older patients.
Author(s): Rosada A, Prpic M, Spieß E, Friedrich K, Neuwinger N, Müller-Werdan U, Kappert K
Publication: J Am Geriatr Soc, 2024, Vol. , Page
PubMed ID: 38314861 PubMed Review Paper? No
Purpose of Paper
This paper evaluated the impact of partially filled tubes on the levels of 14 clinical chemistry analytes in plasma from geriatric patients. Effects of partial filling were further analyzed in groups stratified by patient gender and age (≤80 years and >80 years).
Conclusion of Paper
Relative to matched tubes that were completely filled during blood collection, plasma from collection tubes that were half-filled had significantly higher levels of lactate dehydrogenase (LDH, 51%), glutamic oxaloacetic transaminase (GOT, 19.4%), potassium (12%) and hemolysis index values (408%). The increased levels of affected analytes was consistent, with a increase in underfilled tubes observed in approximately 90% of matched pairs and in all subgroups when the data was stratified by patient gender or age (≤80 years and >80 years). Such increases translated to a higher percentage of specimens with a result above the reference limit than observed for match tubes that were filled completely. Small statistically significant differences in levels of sodium, chloride, inorganic phosphate (PO4), C-reactive protein (CRP), and icterus index were also observed, but not further discussed. Levels of creatinine kinase, creatinine, and urea and the estimated glomerular filtration rate were comparable in filled and underfilled tubes.
Studies
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Study Purpose
This study compared the levels of fourteen clinical chemistry analytes in plasma from matched half-filled and properly filled blood collection tubes using blood collected from geriatric patients. Effects of partial filling were further analyzed in groups stratified by patient gender and age (≤80 years and >80 years). Blood from 156 geriatric patients (>60 years if age) was collected from the antecubital vein into paired lithium heparin tubes during a single venipuncture. While not all diagnoses were specified, 62.9% of the patients were anemic, 8.2% had heart failure, 5% had hyperkalemia, 3.8% had cancer, and 1.3% had kidney failure. From each patient, one tube was properly and completely filled and one tube was half-filled. Plasma was obtained by centrifugation at 3000 g for 10 min at 4°C. Levels of sodium, potassium, chloride, GOT, LDH, creatine kinase, inorganic PO4, urea, and CRP were quantified on a Roche cobas 8000 autoanalyzer. The icterus, hemolysis, and lipemia indices were determined by an autoanalyzer.
Summary of Findings:
Compared to matched completely filled tubes, plasma from tubes that were half-filled during blood collection had significantly higher levels of LDH (51%, P<0.001), GOT (19%, P<0.001), potassium (12%, P<0.001), and hemolysis index values (408%, P<0.001, all). The increases in LDH, GOT, potassium, and hemolysis index that occurred because of underfilling were observed in approximately 90% of the matched pairs examined. When the data was stratified by patient gender or age (≤80 years and >80 years), the increases in the levels of affected analytes in underfilled tubes were observed in all subgroups. Levels that were above reference limit values were observed more often in plasma from underfilled than completely filled tubes for LDH (89% versus 45%), GOT (24% versus 12%), potassium (40% versus 11%), and hemolysis (56% versus 4%). Small statistically significant differences in the levels of sodium (-1%, P<0.001), chloride (0.3%, P<0.001), inorganic PO4 (-1.9%, P<0.001), CRP (-2.6%, P<0.001) and icterus index (-9.4%, P<0.001) were also observed, but not discussed further. Levels of creatinine kinase, creatinine, and urea and the estimated glomerular filtration rate were comparable in completely filled and underfilled tubes.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Other diagnoses
- Not specified
- Cardiovascular Disease
- Neoplastic - Not specified
Platform:
Analyte Technology Platform Electrolyte/Metal Clinical chemistry/auto analyzer Lipoprotein Clinical chemistry/auto analyzer Small molecule Clinical chemistry/auto analyzer Protein Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Aliquots and Components Aliquot size/volume Fully filled tube
Partially-filled tube
Preaquisition Patient gender Female
Male
Preaquisition Patient age ≤80 years
>80 years