Cancer Diagnosis Program | Biorepositories and Biospecimen Research Branch

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Various glycolysis inhibitor-containing tubes for glucose measurement cannot be used interchangeably due to clinically unacceptable biases between them.

Author(s): Saracevic A, Dukic L, Juricic G, Milevoj Kopcinovic L, Mirosevic G, Simundic AM

Publication: Clin Chem Lab Med, 2018, Vol. 56(2), Page 236-241.

PubMed ID: 28746044 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   This study investigated the effect of anticoagulant and collection tube type on the measurement of glucose in blood from twenty healthy volunteers and twenty patients with diabetes. Blood was drawn first into the lithium heparin tube and then in random order into an FX NaF/KOx tube, Glucomedics tube containing EDTA/ sodium flouride/citric acid/sodium citrate), FC mix tube containing sodium EDTA/sodium flouride/ citric acid/ sodium citrate, and S-Monovette GlucoEXACT tube containing sodium flouride /citrate/EDTA. After collection, all specimens were mixed following the appropriate tube instructions and the LiH tube was placed in an ice slurry. Within 15 min of collection, blood was centrifuged at 1800 x g for 10 min at 4˚C. Glucose concentrations were measured within 30 min of collection using the hexokinase method on an Architect c8000 analyzer. Glucose values for specimens collected in the Glucomedics and GlucoEXACT tube were multiplied by 1.16 as suggested by the manufacturer. 

   Summary of Findings:

   Although levels of glucose were comparable between specimens collected in lithium heparin tubes and NaF/KOx tubes, they were significantly different from those in the citrate buffer-containing tubes (Glucomedics, GlucoExact, and FC mix) and differed significantly among the citrate tubes, regardless of patient diabetes status. Significantly higher glucose levels were found in specimens collected in Glucomedics, GlucoExact, and FC mix compared to specimens collected in the lithium heparin tube (7.3%, 3.2%, and 2.0%, respectively), those from patients with diabetes (7.1%, 3.2%, and 1.4%, respectively) and those from healthy individuals (7.5%, 3.1%, and 2.6%, respectively). Importantly, the bias compared to lithium heparin blood exceeded the specified maximum bias when collected into any of the three citrate buffer-containing tubes and the bias between specimens collected in the Glucomedics and GlucoExact or FC mix tubes exceeded the specified maximum bias. Adjusting the multiplication factor from 1.16 to 1.12 decreased the bias for specimens in GlucoExact tubes to -0.1%, which is clinically acceptable, but the bias only decreased to 3.2% (clinically unacceptable) for specimens collected in Glucomedics tubes. 

   Biospecimens

   • Bodily Fluid - Blood

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Diabetes Type 1
   • Normal
   • Diabetes Type 2

   Platform:

   Analyte	Technology Platform
   Carbohydrate	Clinical chemistry/auto analyzer

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Anticoagulant	Sodium fluoride/potassium oxalate Citrate/sodium fluoride EDTA Multiple manufacturers evaluated Lithium heparin
   Clinical chemistry/auto analyzer Specific	Data handling	Values multiplied by 1.16 Values multiplied by 1.12
   Biospecimen Acquisition	Type of collection container/solution	Glucomedics tube GlucoExact tube FC mix tube Lithium heparin tube NaF/KOx tube

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