Stability of complete blood count parameters depends on the storage temperature, storage time, transport position and selected stability criterion.
Author(s): Kayadibi H, Acar IA, Cam S
Publication: Scand J Clin Lab Invest, 2020, Vol. , Page 1-9
PubMed ID: 32597228 PubMed Review Paper? No
Purpose of Paper
This paper investigated the effects of EDTA blood storage temperature (room temperature or 4°C), duration, and tube position on complete blood count (CBC). The changes were assessed using multiple different stability criteria.
Conclusion of Paper
The window of stability was dependent on analyte, storage temperature, storage position and stability criteria used. Importantly, there was no consistent effect of temperature or position on stability across all analytes. While small but statistically significant changes in some CBC parameters were observed after less than 60 min storage, regardless of temperature and tube position, other analytes displayed no significant changes after 4 h, depending on storage temperature and position. Use of the one coefficient of variance percentage (CV%) change threshold did not greatly increase the window of stability for many analytes. The stability windows were longer when of the lower within-subject biological variation (CVI), biologic variation database (BV DES 2014), Royal College of Pathologists of Australasia Quality Assurance Programs 2010 (RCPA 2010), proficiency testing program of the Institute for Quality Management in Healthcare (IQMH), European Federation of Clinical Chemistry and Laboratory Medicine Biological Variation 2019 (EFLM 2019), European Society for External Quality Assessment (ESfEQA), or the Clinical Laboratory Improvement Amendments (CLIA) old and new criteria were applied with stability for greater than 4 h noted under some conditions for the majority of analytes.
Studies
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Study Purpose
This study investigated the effects of EDTA blood storage temperature (room temperature or 4°C), duration, and tube position on CBC. The changes were compared using multiple different stability criteria. Four hundred fifty blood specimens (number of patients and diagnosis unspecified) in K3EDTA evacuated tubes were analyzed within 10 min of collection. After baseline analysis, specimens were stored at room temperature or 4°C in an upright, horizontal, or upside-down position (75 specimens for each temperature/position) for 60, 120, and 240 min. At each timepoint, specimens were allowed to come to room temperature for 5 min, inverted 10 times, and analyzed using a Sysmex XT-4000 hematology analyzer.
Summary of Findings:
Red blood cell (RBC) parameters were affected by storage with significant changes in hemoglobin and mean corpuscular volume (MCV) observed with 60 min, regardless of storage condition, and changes in RBC count, hematocrit, mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), and red cell distribution width CV (RDW-CV) were observed after less than 60 min under some storage conditions. RBC count and hematocrit were most stable at room temperature but were still significantly altered when stored for more than 60 min. MCH, MCHC, and RDW-CV were not significantly altered after 240 min at 4°C when stored horizontally, upside-down, and horizontally or upside-down, respectively. However, when assessed using the 1 CV method, stability of MCV, MCH, and MCHC was 240 min, regardless of storage conditions, and stability of RBC counts and hemoglobin was extended to 240 min when stored upright at room temperature and stability of RDW-CV was extended to 240 min when stored at 4°C. The majority of RBC parameters were stable for 240 min, regardless of storage condition, as determined by lower CVI but MCH was only stable for 240 min when stored at 4°C in a horizontal or upside-down position when using the 1 CV method. None of the red blood cell parameters were found to be affected by storage for 4 h under any condition when the BV DES 2014 or EFLM 2019a criteria were used.
Platelet parameters [mean platelet volume (MPV) and plateletcrit] were significantly altered by storage for 60 min, regardless of storage condition. Platelet counts were most stable at room temperature but were still significantly altered when stored for more than 60 min, regardless of condition. Although platelet distribution width (PDW) was significantly altered after less than 60 min at most storage conditions, PDW was only significantly altered after 120 min when stored horizontally at 4°C. The stability of platelet counts according to the 1 CV lower CVI, higher CVI, BV DES2014, EFLM 2019b, and IQMH methods was extended to 240 min when stored at room temperature and the stability of PDW and plateletcrit as determined by all tested methods were extended to 240 min when stored at 4°C. In contrast, MPV was not stable for more than 60 min using the 1 CV method and was not stable for more than 120 min using the lower CVI method but was stable for 240 min according to the higher CVI method when stored at 4°C (still less than 60 min at room temperature).
Although leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts were altered by storage for 60 min or more under some conditions, they were not significantly altered when stored for 240 min upright at room temperature. Further, leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, and basophil counts were stable for 240 min under all conditions using the 1 CV, lower CVI, higher CVI RCPA 2010, BV DES 2014, and EFLM 2019a criteria.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Not specified
Platform:
Analyte Technology Platform Cell count/volume Hematology/ auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Storage Storage temperature Room temperature
4°C
Storage Storage conditions Upright
Horizontal
Upside down
Storage Storage duration 0 min
60 min
120 min
240 min