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Related Experiment Videos

Minimum specimen volume requirements for routine coagulation testing: dependence on citrate concentration

D M Adcock1, D C Kressin, R A Marlar

  • 1Department of Pathology, Colorado Permanente Medical Group, University of Colorado Health Sciences Center, Denver, USA.

American Journal of Clinical Pathology
|May 12, 1998
PubMed
Summary

Underfilling blood collection tubes with citrate anticoagulant can prolong coagulation test results like prothrombin time (PT) and activated partial thromboplastin time (APTT). Using 3.2% sodium citrate is recommended for accurate PT and APTT testing.

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Area of Science:

  • Clinical Chemistry
  • Hematology
  • Laboratory Medicine

Background:

  • Accurate coagulation testing is crucial for diagnosing and managing bleeding disorders and monitoring anticoagulant therapy.
  • The concentration of citrate anticoagulant and the fill volume of blood collection tubes can influence coagulation assay results.
  • Previous studies have suggested potential issues with underfilled tubes, but optimal parameters require further investigation.

Purpose of the Study:

  • To evaluate the impact of varying sample volumes and sodium citrate concentrations (3.2% and 3.8%) on prothrombin time (PT) and activated partial thromboplastin time (APTT) results.
  • To determine acceptable minimum fill volumes for routine coagulation assays using different citrate concentrations.
  • To provide evidence-based recommendations for blood collection and handling in coagulation testing.

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Main Methods:

  • Samples from healthy individuals and patients on oral anticoagulants were collected into evacuated tubes containing either 3.2% or 3.8% sodium citrate.
  • Tubes were filled to various volumes ranging from 3.0 to 5.0 mL to simulate underfilling.
  • Prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured, and results were compared across different fill volumes and citrate concentrations.

Main Results:

  • Underfilling significantly prolonged both PT and APTT results, particularly with 3.8% sodium citrate.
  • With 3.8% citrate, significant differences in PT were observed at fill volumes below 80% and in APTT below 90%.
  • Using 3.2% citrate, acceptable PT results were obtained with fill volumes as low as 60%, and APTT results with fill volumes as low as 70% of the recommended volume.

Conclusions:

  • The fill volume of citrate anticoagulant tubes critically impacts the accuracy of PT and APTT assays.
  • Artifactual prolongation of coagulation tests due to underfilling is more pronounced with 3.8% sodium citrate compared to 3.2%.
  • The study supports the use of 3.2% sodium citrate, as lower fill volumes (60% for PT, 70% for APTT) yield acceptable results, enhancing laboratory testing reliability.