Order of Draw

MOA: Antiglycolytic Agents

inhibits glycolysis

MOA: Lavender Top

chelates calcium

MOA: Green Top

inhibits thrombin

MOA: Light Blue Top

binds to calcium in an unionized form

Additive: Gray Top

1. Sodium fluoride

2. Lithium Iodoacetate

Anticoagulant: Sodium Fluoride

Potassium Oxalate

Anticoagulant: Lithium Iodoacetate

Potassium Heparin

Gray Top: Sodium Fluoride

• preserves glucose for up to 3 days

• Blood glucose & alcohol level determinations

• #inversions: 8

Gray Top: Lithium Iodoacetate

• preserves glucose for 24 hrs

• blood glucose & alcohol level determination

• #inversions: 8

Tests: Gray Top

• Coagulation testing

Tests: Gray Top (Lithium oxalate)

• prevent clotting of blood body fluids

Tests: Gray Top (Double oxalate)

• RBC count

• RBC parameters

• ESR determination

• Platelet-Poor Plasma (PPP)

  • <10,000 platelets/uL

  • heavy centri. spin at 1500-2000g for 10 mins.

• Platelet-Rich Plasma (PRP)

  • 200,000-300,000 platelet/uL

  • light centri. spin at 50-100g for 10 mins

Clot Activators

accelerates clotting of samples

Additive: Red Top Glass

None

Additive: Red Top Plastic

Silica particles

Red Top Plastic

Orange Top

STAT serum determinations

#inversions: 5

Additive: Orange Top

Thrombin

MOA: Orange Top

cleaves fibrinogen into fibrin

Serum Separator Gel (SST)

inert material that undergoes a temporary change in viscosity during the centrifugation process

Additive: Gold Top

Thixotropic Gel

Gold Top

#inversions: 5

separated packed red cell from serum

Anticoagulants

prevent the blood from clotting

Additive: Lavender Top

Ethylenediaminetetraacetic acid

Lavender Top: Optimal Anticoag. Conc.

1.5-2.2mg/mL of blood

Tests: Lavender Top

Whole Blood/Plasma

Routine Hematological Studies

• CBC (RBC, WBC, Platelets_

• Reticulocyte Count

• ESR Determination

  • modified Westergren method of ESR

• RBC Parameters (HGB, HCT)

• RBC Indices (MCV, MCH, MCHC)

• peripheral Blood Smear

• Differential count

Lavender Top

K2 EDTA (most preferred)

K3 EDTA

Li EDTA

Na2 EDTA

#inversions: 8

Insufficient EDTA (overfilled)

Presence of clots or microclots

Excessive EDTA (underfilled)

• falsely decreased

  • HCT

  • ESR

• falsely increased

  • MCHC

  • Platelet

• degenerative changes in WBC

3.2% sodium citrate

used when platelet clumping (aggregation) is encountered when examining the smear

Additive: Green Top

Heparin

Green Top: Optimal Anticoag. Conc.

15-20 units/mL of blood

Tests: Green Top

Plasma

• STAT Chem. determinations

• Osmotic Fragility Testing

• Blood Gas Analysis

• Electrolytes

• RBC Count

• RBC Parameters

Green Top: Formulations

1. Ammonium Heparin

2. Sodium Heparin

3. Lithium Heparin

Lithium Heparin

• causes the least interference in chemistry testing

• must not be used for lithium determinations

Tests: Green Top (Lithium Heparin)

• anticoagulant for plasma

• whole blood chemistry assays

Sodium Heparin

must not be used for sodium determinations or electrolyte panel

Ammonium Heparin

must not be used for ammonia level determinations

Anticoagulant: Heparin

• induces cellular clumping

• false increase:

  • WBC count

• false decrease:

  • platelet count

Not to be used for 1) blood smear & 2) coagulation studies

Heparin

• 1) causes

  • morphologic distortion of platelets & WBCs

  • bg staining w/ Romanowsky stains

    • Wright’s & Giemsa

• 2) inhibits Throbin

Additive: Light Blue Top

3.2% Sodium Citrate

Light Blue Top: Blood to Anticoagulant

9:1

Tests: Light Blue Top

Plasma

• Coagulation Tests

  • PT

  • PTT

  • APTT

• Modified Westergren method of ESR for blood collected with EDTA

• Platelet aggregometry tests

• Platelet Counts

  • when platelet satellitism or clumping is encountered

Light Blue Top: Inversions

#: 3-4

Forceful mixing & excessive inversions can activate platelets and shorten clotting times

Anticoagulant: Yellow Top Sterile

Sodium Polyanethol Sulfonate (SPS)

Test: Yellow Top Sterile

Whole Blood

• Blood culture

Anticoagulant: Yellow Top Non-sterile

Whole Blood

• Acid Citrate Dextrose (ACD)

Test: Yellow Top Non-sterile

• Paternity testing

• Blood bank tests

• HLA testing (tissue typing)

• DNA testing

Anticoagulant:

1. Tan Top

2. Royal Blue Top

3. Pink Top

K2 EDTA

Anticoagulant: White Top

K2 EDTA with Gel Separator

Anticoagulant: Black Top

3.8% Sodium citrate

Black Top

forms calcium salts to remove calcium

#inversions: 8

Test: Tan Top

Plasma

• Lead Determination

Tan Top

Certified to contain >0.01ug/mL of Lead

#inversions: 8

Test: Royal Blue Top

Plasma

• Trace Elements

• Nutritional Chemistry

Royal Blue Top

contains very low elements of trace elements

#inversions: 8

Test: White Top

Plasma

• Molecular Tests

• PCR and DNA tests

White Top

forms calcium salts

#inversions: 8

Test: Black Top

Plasma

• Molecular Tests

  • Westergren method of ESR determination

Black Top: Blood to anticoagulant

4:1

Test: Pink Top

Whole Blood/Plasma

• Blood Bank Test

  • Crossmatching

• Immunohematology

Pink Top

with special crossmatch label approached by AABB

#inversions: 8

Venipuncture: Order of Draw

1. Yellow (SPS)

2. Light Blue Top

3. Red Top

   • Orange

4. Gold

5. Light Green

6. Dark Green

7. Lavender

8. Gray

9. Yellow (non-sterile)

Test: Yellow-Black Top

• Microbiology

  • aerobes

  • anaerobes

  • fungi

Additive: Yellow-Black Top

Broth Mixture

Yellow Black Top

preserves vitality of microorganisms

Capillary Blood: Order of Draw

1. Blood Gas Analysis

   • Cap ends, rotate between palms to mix

2. Slides

3. EDTA microcollection tube (10)

4. Other Anticoagulation microcollection tubes

   • Lithium Heparin (10)

   • Lithium Heparin w/ Gel separator (10)

   • Sodium fluoride/K Oxalate (10)

5. Serum microcollection tubes

   • Clot activator (5)

   • No additive (0)

6. Newborn Blood Spot Card

   • Recommended to be collected separately