2nd part Julia pg 1-3

Concentration: 1-2 mg/mL of blood (K oxalate), 0.01 mL of aq. 20% solution per mL of blood, 1 gt per mL of blood

Oxalate (Na, K, ammonium, lithium, or dioxalate)

3.2-3.8g/dL

Citrate (Na Citrate) Concentration:

0.105M or 0.129M, 1:9

Citrate (Na Citrate) Light blue top-

1:4

Citrate (Na Citrate) Black top-

Acid Citrate Dextrose (ASD)

This is anti-coagulant preservative for whole blood and red blood cells.

Dextrose

This is a preservative and not an anticoagulant and it functions to provide or maintain cell energy, in order to preserve the viability of Red blood cells. It is usually used in blood bag preservative

EDTA (ethylenediaminetetraacetic Acid)

A lavender top tube or pink. Its mechanism chelates calcium, preventing coagulation.

1-2 mg/mL of blood

EDTA Concentration

EDTA (ethylenediaminetetraacetic Acid)

Preferred anticoagulant for hematology such as CBC, and blood smear due to good preservation of cell morphology and it is not suitable for calcium potassium assays because it interferes with the testing. It causes falsely elevated results with those tests.

EDTA 2 forms

1. Versene - Disodium EDTA, sometimes used in a very rare occasion. 2. Sequestene -Dipotassium EDTA, most commonly used and preferred for blood collection tubes used in hematology and chemistry tests.

Versene

Disodium EDTA, sometimes used in a very rare occasion

Sequestene

Dipotassium EDTA, most commonly used and preferred for blood collection tubes used in hematology and chemistry tests.

Sodium Fluoride

It inhibits glycolysis for preserving glucose for blood samples.

10mg/mL of blood

Concentration of Sodium Fluoride

Sodium Fluoride

2 types: 1. Sodium fluoride - prevents glycolysis for 3 days. 2. Lithium iodoacetate - inhibits glycolysis for 24 hours. It is used for glucose testing with potassium oxalates. Gray top tube

Sodium Fluoride (type)

prevents glycolysis for 3 days.

Lithium iodoacetate

inhibits glycolysis for 24 hours. It is used for glucose testing with potassium oxalates. Gray top tube

Heparin

It has different forms Sodium (Na), Potassium (K), Lithium, and ammonium salts. It is a natural anticoagulant, we have heparin in our body specifically in the liver. It acts quickly and is widely used in laboratory testing as an ideal universal anticoagulant that causes less interference in tests than other coagulation tests. Used for blood gas analysis in arterial or veins blood to prevent clotting without altering the gas composition especially when fast processing is very essential. Action: Antithrombin and antithromboplastin (Heparin enhances the activity of these two clotting factors. Anticoagulant protein, antithrombin 3 and antithrombinplastin. It inhibits thrombin and factor 10a preventing the conversion of fibrinogen to fibrin which is essential for clot formation.)

0.2mg/mL of blood

Heparin Concentration

Heparinized plasma

it is a test that requires a fast turn around time(STAT)

Lithium heparin

most common form. Used in clinical chemistry labs. It is a green top tube usually marked with lit tube heparin. Use in electrolytes, renal function, liver enzyme, glucose and lipid testing, Must be avoided when testing for lithium level testing and folate assays

Sodium heparin

less commonly used for general chemistry tests.

Potassium Heparin

very rare. Potentially impact on potassium levels

Ammonium Heparin / Ammonium salts

very rarely used limited to research application.

Sodium polyanethol sulfonate (SPS)

Primarily used for microbiology specifically in blood culture collection. The mechanism of action is that it is an anticoagulant and antimicrobial agent by inhibiting coagulation, neutralizing the complement system, inactivating certain antibiotics and suppressing phagocytosis. Tube color is usually yellow top tube that are prefilled with SPS. It cannot be used in hematology and chemistry testing

1 to 2.5 mg/mL of blood

Concentration of SPS

Glass Beads

Its mechanism is their are mechanical method go prevent clotting from disrupting the clot formation. Rarely used but may be used for serum separator tubes

Red Top Tubes

No anticoagulant/additives. Blood is allowed to clot naturally. its serum is used for chemistry, blood bank, and immunology assays

Red/Gray and Gold Tubes / tiger top

Contains a clot activators and separation gel. Referred to as SST or Serum Separated Tubes. Mostly used in chemistry test

Blood cultures (sterile collections) Tube Stopper Color

Yellow SPS / Sterile media bottle

Blood cultures (sterile collections)

Rationale for Collection Order:Minimizes chances of microbial contamination

Light blue

Coagulation tubes Tube Stopper Color

The first additives tube in the order because all other additives affect coagulation tests

Coagulation tubes Rationale for Collection Order

Red

Glass nonadditive tubes Tube Stopper Color

Prevents contamination by additives in other tubes

Glass nonadditive tubes Rationale for Collection Order

Red

Plastic clot activator tubes Tube Stopper Color

Filled after coagulation tests because silica particles activate clotting and affect coagulation tests (carry-over of silica into subsequent tubes can be overridden by anticoagulant in them)

Plastic clot activator tubes Rationale for Collection Order

Red and Gray rubber / Gold plastic

Serum separator tubes (SSTs) Tube Stopper Color

Green and gray rubber / Light-green plastic

Plasma separator tubes (PSTs) Tube Stopper Color

Green

Heparin tubes Tube Stopper Color

Heparin affects coagulation tests and interferes in collection of serum specimens, cause the least interference in tests other than coagulation test

Heparin tubes Rationale for Collection Order

Lavender / Pink

EDTA TUBES Tube Stopper Color

Pearl Top

Plasma preparation tubes (PPTs) Tube Stopper Color

Responsible for more carry-over problems than any other additive

elevates Na and K levels, chelates and decreases calcium and iron levels, elevates PT and PTT results

Gray

Oxalate/fluoride tubes Tube Stopper Color

Sodium fluoride potassium oxalates and affect sodium and potassium levels, respectively, after hematology tubes because oxalates damage cell membranes and cause abnormal RBC morphology. Oxalate interferences in enzyme reactions.

Oxalate/fluoride tubes Rationale for Collection Order

Citrate (Contaminating Additive)

Tests Potentially Affected: Alkaline phosphatase, Calcium, Phosphorus, Partial thromboplastin, Potassium, Protime

EDTA (Contaminating Additive)

Tests Potentially Affected: Alkaline phosphatase, Calcium, Creatine kinase, Partial thromboplastin, Potassium, Protime, Serum iron, Sodium

Heparin (all formulations) (Contaminating Additive)

Tests Potentially Affected: Activated clotting time, Acid phosphatase, Calcium (some test methods), Partial thromboplastin, Protime, Sodium (sodium formulations), Lithium (lithium formulations)

Oxalates (Contaminating Additive)

Tests Potentially Affected: Acid phosphatase, Alkaline phosphatase, Amylase, Calcium, Lactate dehydrogenase, Partial thromboplastin, Potassium, Protime, Red cell morphology

Silica (clot activator) (Contaminating Additive)

Tests Potentially Affected: Partial thromboplastin time, Protime

Sodium fluoride (Contaminating Additive)

Tests Potentially Affected: Sodium Urea nitrogen