The use of heparin in preparing samples for blood-gas analysis

Heparin is the only anticoagulant used to prepare samples for blood-gas analysis. There are two ways in which heparin can interfere with results. The first is high heparin concentration in blood, and the second is heparin dilution of blood if liquid rather than dried (lyophilized) heparin is used. Traditional blood-gas analytes (pH, pCO2, and pO2) are less affected than electrolytes (particularly ionized calcium), also measured on modern blood-gas analyzers. The sample requirements as far as heparin is concerned are thus less exacting if only pH, pCO2, and pO2 are to be measured. For these analytes, it is still essential that the heparin (either sodium or lithium) concentration is less than 200 IU/mL blood and that the blood is not diluted more than 5%. The inclusion of electrolytes in the test repertoire excludes the use of sodium heparin in favor of lithium heparin. The inclusion of ionized calcium in the test repertoire demands that the heparin should be lyophilized, and the concentration should not exceed 10 IU/mL blood, unless a specialized heparin that eliminates the effect of calcium binding by heparin is used. Whatever the heparin formulation, it is essential for accurate results that the correct volume of blood is sampled to achieve a correct heparin concentration (and dilution, if liquid heparin is used), and that blood and anticoagulant are well mixed immediately after sampling. One of the most common practical problems associated with blood-gas analysis is inadequate anticoagulation and the formation of small blood clots that can block the sample pathway of blood-gas analyzers and invalidate results. Inadequate mixing of specimen with heparin is usually the problem. Clearly, the lower the heparin concentration the greater is the risk that poor mixing technique will give rise to inadequate anticoagulation and the associated problems.