Order of draw, phlebotomy tubes, common labs - (HSTP UNIT 8)

learn by 3/27/26

1^st:  Yellow

• Additive: SPS

• Common labs: Blood cultures – Always drawn first to prevent contamination.

• Invert 8-10 times.

2^nd:  Blue

• Additive: Sodium citrate

• Common labs: PT, PTT, INR, D-dimer

• Invert 3-4 times.

3^rd:  Red

• Additive:  Usually none, but some have clot activator 

• Common labs:  Serum tests, serology/immunology (HIV, hepatitis C), therapeutic drug levels (Phenytoin – seizure medication) 

• Invert 5 times.

4^th:  Gold (Tiger Top, SST – serum separator tube)

• Additive: Clot activator + gel that creates a barrier between serum and blood after centrifuge

• Common labs: Comprehensive metabolic panels (CMP), basic metabolic panels (BMP), lipid panels, liver and thyroid function tests

• Invert 5 times.

5^th:  Green

• Additive: Heparin

• Common labs: Comprehensive metabolic panels (CMP), basic metabolic panels (BMP), electrolytes like sodium, potassium, chloride, and STAT tests (clot prevention allows for quick analysis)

• Invert 8-10 times.

6^th:  Lavender

• Additive: EDTA

• Common labs: Complete blood count (CBC), hemoglobin and hematocrit, hemoglobin A1C

• Invert 8-10 times.

7^th:  Pink

• Additive: Spray-dried potassium EDTA

• Common labs: Blood typing, cross matching, antibody screening (used for blood banks)

• Invert 8-10 times.

8^th: Gray

• Additive: Sodium fluoride and potassium oxalate

• Common labs: Glucose (additives keep levels stable and prevent glycolysis), lactic acid, blood alcohol content

• Invert 8-10 times.

Red Blood Cells: Complete Blood Count (CBC) --- LAVENDER TOP

Females 4.0-5.5 million per microliter, Males: 4.5-6.1 million per microliter

White Blood Cells: Complete Blood Count (CBC) --- LAVENDER TOP

4,000-11,000 per microliter

Platelets: Complete Blood Count (CBC) --- LAVENDER TOP

150,000-450,000 per microliter

Hemoglobin (Hgb): Complete Blood Count (CBC) --- LAVENDER TOP

Females: 12-16 g/dL, Males 14-18 g/dL

Hematocrit (HCT): Complete Blood Count (CBC) --- LAVENDER TOP

Females 36-48%, Males 40-54%

Normal/healthy: Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours. --- GREY TOP

70-99 mg/dL

Prediabetes:Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours. --- GREY TOP

100-125 mg/dL

Diabetes: Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours. --- GREY TOP

126 mg/dL or higher (A second confirmation test is needed for diagnosis.)

if low or high: Fasting Blood Glucose – Fasting means the patient has not eaten for at least 8 hours. --- GREY TOP

If low: Hypoglycemia, insulin overdose

If high: Diabetes, stress, infection

Random Blood Glucose – Not Fasting --- GREY TOP

Normal: 200 mg/dL or higher + symptoms likely means the patient is diabetic.

Symptoms: Frequent urination, excessive thirst, blurred vision, fatigue

Hemoglobin A1C Level – Determined by average glucose levels over approximately 3 months --- LAVENDER TOP

Normal: Below 5.7%

Prediabetes: 5.7%-6.4%

Diabetes: 6.5% or higher

Sodium (Na+)   --- GOLD TOP (SST, TIGER)

• 135-145 mEq/L

• If low: Overhydration, kidney disease

• If high: Dehydration

Potassium (K+) --- GOLD TOP (SST, TIGER)

3.5-5.0 mEq/L

If low: Vomiting, potassium-wasting diuretics, will see muscle weakness and heart rhythm abnormalities

If high: Kidney disease, acidosis, will see dangerous cardiac arrhythmias

Calcium (Ca) --- GOLD TOP (SST, TIGER)

8.6-10.2 mg/dL

If low: Hypoparathyroidism, vitamin D deficiency, will see muscle spasms

If high: Hyperparathyroidism, cancer

You have 4 small parathyroid glands behind your thyroid that regulate blood calcium. This is done through bones releasing or reabsorbing calcium.

AST – Liver Function --- GOLD TOP (SST, TIGER)

10-40 U/L

If high: Liver damage, muscle injury

ALT – Liver Function --- GOLD TOP (SST, TIGER)

7-56 U/L

If high: Liver disease, hepatitis

Alkaline Phosphate (ALP) – Liver Function --- GOLD TOP (SST, TIGER)

44-147 U/L

If high: Liver or bone disease

Total Bilirubin – Liver Function --- GOLD TOP (SST, TIGER)

0.1-1.2 mg/dL

If high: Liver disease, hemolysis

Thyroid Stimulating Hormone (TSH) --- GOLD TOP (SST, TIGER)

0.4-4.0 mIU/L

If low: Hyperthyroidism

If high: Hypothyroidism

Prothrombin Time (PT) – Coagulation Studies --- LIGHT BLUE TOP

11-13.5 seconds

If high: Clotting disorders, liver disease

Partial Thromboplastin Time (PTT) – Coagulation Studies --- LIGHT BLUE TOP

25-35 seconds

If high: Heparin therapy, clotting disorders

INR – Coagulation Studies --- LIGHT BLUE TOP

0.8-1.2 (for individuals who aren’t on anticoagulants), 2.0-3.0 (for individuals who are on a therapeutic dose of Warfarin therapy, such as patients with atrial fibrillation or deep vein thrombosis)

If high: Warfarin therapy, bleeding risk

Total Cholesterol – Lipid Panel --- GOLD TOP (SST, TIGER)

Less than 200 mg/dL

If high: Cardiovascular risk

Low Density Lipoprotein (LDL) – “Bad Cholesterol” on a Lipid Panel – LOWER is better. --- GOLD TOP (SST, TIGER)

Less than 100 mg/dL

If high: Atherosclerosis risk (chronic disease where fatty cholesterol plaques develop in arteries, causing them to narrow, harden, and restrict blood flow)

High Density Lipoprotein (HDL) – “Good cholesterol” on a Lipid Panel – HIGHER is better. --- GOLD TOP (SST, TIGER)

Greater than 40 mg/dL

If low: Cardiovascular risk

If high: Protective

Triglycerides – Lipid Panel – Fats in the blood --- GOLD TOP (SST, TIGER)

Less than 150 mg/dL

If high: Risk for cardiovascular disease, heart attack, stroke, increased risk of diabetes

Blood Urea Nitrogen (BUN) --- RED TOP OR GOLD TOP (SST, TIGER)

7-20 mg/dL

If low: Overhydration, malnutrition, or a very low protein diet

If high: Kidney disease, high protein intake, dehydration

Creatinine --- RED TOP OR GOLD TOP (SST, TIGER)

0.6-1.3 mg/dL

If low: Decreased muscle mass, malnutrition, liver disease

If high: Kidney disease

Glomerular Filtration Rate (GFR) --- RED TOP OR GOLD TOP (SST, TIGER)

Greater than 60 mL/min.

If low: Kidney disease\