Impact of low volume citrate tubes on results of first-line hemostasis testing.
Author(s): Salvagno GL, Demonte D, Poli G, Favaloro EJ, Lippi G
Publication: Int J Lab Hematol, 2019, Vol. , Page
PubMed ID: 30985988 PubMed Review Paper? No
Purpose of Paper
This paper investigated if prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen were affected by the type of low-volume sodium citrate tube used for collection.
Conclusion of Paper
Although significant bias in PT, APTT, and fibrinogen was found in most comparisons, the bias exceeded the minimum quality specification for PT only when collected in 1 mL Vacuettes and for APTT when blood was collected in 0.5 mL Micro Test tubes compared to all other tube types. For fibrinogen, the bias exceeded the minimum threshold for blood collected in 0.5 mL Micro Test compared to all of the other tube types with the exception of the 0.5 mL MiniCollect. Importantly, PT, APTT, and thrombin time were very strongly correlated among the tube types (≥0.99, ≥0.93, and ≥0.96; respectively).
Studies
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Study Purpose
This study compared PT, APTT, and fibrinogen in blood collected in five different low-volume sodium citrate tubes. Blood was collected from 34 patients on warfarin therapy and 17 healthy volunteers into tubes containing 3.2% buffered sodium citrate. Blood from the right arm was collected into three different evacuated tubes: a 3 mL Vacuette, a 2 mL Vacutest, and a 1 mL Vacuette in a random order using a 19-gauge straight needle. Blood from the left arm blood was drawn into a 5 mL syringe using a 19-gauge needle and then transferred within 2 min into 0.5 mL MiniCollect and 0.5 mL Micro Test tubes. Blood was centrifuged at 1300 x g for 15 min and prothrombin time, APTT, and fibrinogen were determined on a ACL TOP 700 hematology autoanalyzer within 1 h of collection. The bias was compared to the minimum quality specifications for bias determined by Roche (± 3.0% for PT, ± 3.4% for APTT, and ± 4.8% for fibrinogen).
Summary of Findings:
Significant bias in PT was found when 3 mL Vacuette tubes were compared with 1 mL Vacuette (-7.6%, P<0.001), 2mL Vacutest (-1.3%, P<0.001), and 0.5 mL Micro test tubes (-2.9%, P<0.001); when 1 mL Vacuettes were compared with 0.5 mL MiniCollect tubes (7.6%, P<0.001), 2mL Vacutest tubes (6.3%, P<0.001), and 0.5 mL Micro Test tubes (4.7%, P<0.001); when 0.5 mL Minicollect tubes were compared with 2 mL Vacutest tubes (-1.3%, P=0.002) and 0.5 mL MicroTest tubes (-2.9%, P<0.001); and when 2 mL Vacutest tubes were compared with 0.5 mL Microtest tubes (-1.6%, P<0.001). However, the bias only exceeded the 3% threshold when blood collected in 1 mL Vacuettes was compared with any of the other tube types. Significant bias in APTT was found when 3 mL Vacuette tubes were compared with 1 mL Vacuette tubes (-3.4%, P<0.001), 0.5 mL MiniCollect (-2.9%, P<0.001), 2 mL Vacutest (-1.6%, P=0.009), and 0.5 mL Micro test (-13.2%, P<0.001); when 1 mL Vacuettes were compared with 2 mL Vacutest (1.9%, P=0.005) and 0.5 mL Micro Test (-9.8%, P<0.001); and when 0.5 mL Micro Test tubes were compared with 0.5 mL MiniCollect (-10.4%, P<0.001) or 2mL Vacutest (-11.6%, P<0.001) tubes. However, the APTT bias only exceeded the 3.4% threshold for blood collected in 0.5 mL Micro Test compared to the other tube types. Significant bias in fibrinogen was found when blood in 3 mL Vacuettes was compared with 0.5 mL MiniCollect (2.4%, P=0.007), 2 mL Vacutest (2.7%, P=0.001), and 0.5 mL Micro Test (7.1%, P<0.001); when 1 mL Vacuettes were compared to 0.5 mL MiniCollect (2.0%, P=0.036), 2 mL Vacutest (2.3%, P=0.013), and 0.5 mL Micro Test (6.8%, P<0.001); when 0.5 Micro Test were compared with 0.5 mL MiniCollect (4.7%, P<0.001) and 2 mL Vacutest (4.5%, P<0.001) tubes. However, the fibrinogen bias only exceeded the 4.8% threshold when blood collected in 0.5 mL Micro Test was compared to the other tube types with the exception of the 0.5 mL MiniCollect. PT, APTT, and thrombin time were very strongly correlated among the tube types (≥0.99, ≥0.93, and ≥0.96; respectively). The authors state the results were the same in patients on warfarin therapy and in healthy patients.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Other diagnoses
- Normal
Platform:
Analyte Technology Platform Morphology Hematology/ auto analyzer Glycoprotein Hematology/ auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Biospecimen Aliquots and Components Aliquot size/volume 0.5 mL
1.0 mL
2.0 mL
3.0 mL
Biospecimen Acquisition Type of collection container/solution 3 mL Vacuette
2 mL Vacutest
1 mL Vacuette
0.5 mL MiniCollect
0.5 mL Micro Test