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Drawing specimens for coagulation testing: is a second tube necessary?

D L McGlasson1, L More, H A Best

  • 1Wilford Hall Medical Center, Lackland AFB TX 8236-5319, USA. davemcglasson.hotmail.com

Clinical Laboratory Science : Journal of the American Society for Medical Technology
|October 28, 1999
PubMed
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The National Committee for Clinical Laboratory Standards (NCCLS) recommendation to collect a second coagulation specimen tube may be unnecessary. This study found no significant differences between the first and second tubes across multiple testing systems, suggesting guideline revision.

Area of Science:

  • Clinical Laboratory Science
  • Hematology
  • Diagnostic Testing

Background:

  • The National Committee for Clinical Laboratory Standards (NCCLS) currently recommends collecting coagulation specimens in the second or third tube.
  • Previous studies investigating this recommendation used only a single reagent/instrument system.

Purpose of the Study:

  • To evaluate the necessity of the NCCLS recommendation for collecting a second coagulation specimen tube.
  • To compare coagulation test results from the first and second tubes across multiple reagent/instrument systems.

Main Methods:

  • Blood samples were collected from 95 subjects (15 normal, 80 on coumadin therapy) into two blue-stoppered tubes without a discard tube.
  • Prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (APTT) were performed on both tubes using three different reagent/instrument systems (photo-optic, mechanical, nephelometric).

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Main Results:

  • No statistically significant differences were observed between the first and second tubes for PT (seconds), INR, or APTT across all three tested reagent/instrument combinations.
  • Results were consistent regardless of the clot detection method (photo-optic, mechanical, nephelometric).

Conclusions:

  • The NCCLS guidelines requiring a second tube for coagulation testing may be unnecessary.
  • Consideration should be given to eliminating this requirement in future NCCLS guideline revisions based on these findings.