Underfilling of vacuum blood collection tubes leads to increased lactate dehydrogenase activity in serum and heparin plasma samples.
Author(s): Neuwinger N, Meyer Zum Büschenfelde D, Tauber R, Kappert K
Publication: Clin Chem Lab Med, 2020, Vol. 58, Page 213-221
PubMed ID: 31665108 PubMed Review Paper? No
Purpose of Paper
This paper investigated the effects of tube type, fill volume, and delay to centrifugation on blood analytes and hemolysis indicators in serum and heparin plasma.
Conclusion of Paper
Hemolysis index and potassium concentration were lower and lactate dehydrogenase activity was higher in heparin plasma than serum but levels of other analytes were comparable. Lactate dehydrogenase values, potassium, and hemolysis index were higher in underfilled serum and lithium heparin tubes than filled tubes and while lactate dehydrogenase levels and the hemolysis index were modestly correlated in underfilled lithium heparin and serum tubes (r=0.64 and r=0.86; respectively), they were only weakly correlated in filled lithium heparin and serum tubes (r=0.46 and r=0.26; respectively). Delay to centrifugation resulted in significant increases in lactate dehydrogenase and the hemolysis index in both serum and heparin plasma, but levels for total cholesterol, sodium, chloride, and creatine kinase levels were unaffected.
Studies
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Study Purpose
This study investigated the effects of tube type, fill volume, and delay to centrifugation on blood analytes and hemolysis indicators in serum and lithium heparin plasma. Blood was collected by venipuncture using a 21-gauge needle from 31 healthy volunteers (age range of 28–64 y, mean of 47 y) into serum separator and lithium heparin tubes. Tubes were either filled completely or filled to approximately 50%, kept at room temperature for either 30 min or for 4 h, and then centrifuged at 3000 × g for 10 min at 20 °C. Potassium, sodium, chloride, lactate dehydrogenase, creatine kinase, total cholesterol, and indices for hemolysis, icterus, and lipemia were analyzed using an automated chemistry analyzer.
Summary of Findings:
Compared to serum, heparin plasma had significantly lower hemolysis index (-13.9%, P<0.001) and potassium concentration (-7.4%, P<0.05) and higher lactate dehydrogenase activity (+10.0%, P<0.001). Specimens from partially filled rather than filled serum and lithium heparin tubes had higher levels of lactate dehydrogenase (+21.6%, P<0.001 and +28.3%, P<0.001; respectively) and potassium (+4.2%, P<0.001 and +5.3%, P<0.001; respectively) and a higher hemolysis index (+260.8% and +210.0%, respectively) were higher in underfilled serum and lithium heparin tubes compared to filled tubes. While lactate dehydrogenase levels and the hemolysis index were modestly correlated in underfilled lithium heparin and serum tubes (r=0.64 and r=0.86; respectively), they were only weakly correlated in filled lithium heparin and serum tubes (r=0.46 and r=0.26; respectively). A 4 h delay to centrifugation resulted in significant increases in lactate dehydrogenase and the hemolysis index in both serum (12.7% and 5.8%, respectively; P<0.05) and heparin plasma (65.7% and 48.8%, respectively; P<0.05 all), but levels for total cholesterol, sodium, chloride, and creatine kinase levels were unaffected.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Normal
Platform:
Analyte Technology Platform Small molecule Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Protein Clinical chemistry/auto analyzer Lipid Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Aliquots and Components Aliquot size/volume Filled blood tube
Unfilled blood tube
Biospecimen Aliquots and Components Centrifugation Centrifugation delays investigated
Biospecimen Aliquots and Components Blood and blood products Plasma
Serum
Storage Storage duration 30 min
4 h