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PBT Blood Collection
ASCP Review for Blood Collection Additives
| Term | Definition |
|---|---|
| CAUTION: Never transfer blood collected in an additive tube into another additive tube. | Additives may interfere with each other or the testing process. If the additives are the same, and excess of additive is created, which can negatively affect testing. |
| Blood Collection Additives: | The type of additive required for blood collection generally depends upon the Test that has been ordered. |
| Additives are available in: | Liquid, Spray-Dried and Powder Forms. >Powdered tapped prior to use to settle >Inverted 3-10 times |
| Tube Inversion: | Requires turning the wrist 180 degrees and back. |
| Caution: Never Shake or Vigorously mix Tubes | Causes hemolysis making specimens unsuitable for testing. |
| ANTICOAGULANTS - Most Common: EDTA, Citrates, Heparin, & Oxaltes | Are substances that prevent blood from clotting (coagulating) >Must be mixed immediately after collection to prevent microclot formation. >Gentle mixing prevents Hemolysis. >Separate naturally or if centrifuged. |
| ANTICOAGULANTS - Two Methods: | 1. Chelating (binding), precipitating calcium so it is unavailable to the coagulation process. 2. Inhibiting the formation of Thrombin needed to convert Fibrinogen to Fibrin in coagulation process. |
| ANTICOAGULANTS - Used for: | >Tests that require whole Plasma |
| ANTICOAGULANTS - EDTA: (EXCESS EDTA = under filled tubes result in RBCs shrinking changing CBC results) | >Available as a powdered di-potassium K2 >Available as a liquid tri-potassium K3 salt >Prevents coagulation by binding (chelating) calcium >Lavender, Purple, Pink, Pearl, Gray and Royal Blue top tubes >Must be mixed by inversion immediately 8-10times |
| ANTICOAGULANTS - EDTA: Additive in Lavender and Pink tops for Department: | >Purple or Lavender top tubes for Hematology >Pink top tube for Blood Bank ( with special Blood Bank patient ID label & wrist band. >CLSI Recommends using Spray Dried EDTA to avoid dilution lowering Hemoglobin, RBC, WBC, Platelets and packed cell volum |
| ANTICOAGULANTS - EDTA: Additive in Gray top with Sodium Fluoride for Department: | >Gray top for Chemistry (Glucose testing) |
| ANTICOAGULANTS - EDTA: Additive in Royal Blue with Lavender label & Pearl top for Department: | >Royal Blue with Lavender Label for Chemistry >Pearl top with Thixotropic gel separator for Plasma Preparation Tubes (PPT) for |
| ANTICOAGULANTS - EDTA - Hematology & Blood Banking | Used to both departments test because: >Preserves cell morphology and inhibits platelet aggregation better than in other. > |
| ANTICOAGULANTS - CITRATES: Lt Blue Stopper | >Bind or chelate calcium >Used for Coagulation department tests: PT & aPTT because it preserves Coagulation Factors. >Lt Blue Stopper Tubes |
| ANTICOAGULANTS - CITRATE: ESR | Sodium Citrate is an additive to Special Erythrocyte Sedimentation Rate (ESR) tubes with Black Stoppers. |
| ANTICOAGULANTS - CITRATES: Mixing | To avoid microclotting citrates must be mixed by inversion 3-4 times after collection >vigorous mixing can activate platelets and shorten clotting time giving erroneous results. |
| ANTICOAGULANTS - CITRATES: 9:1 ratio | Blue top tubes contain a 9:1 ratio of blood to anticoagulant with filled to stated volume. >under filled will prolong clotting time so not acceptable and will be rejected. |
| ANTICOAGULANTS - CITRATES: Centrifuge | Coagulation tests are performed on Plasma, so specimens must first be centrifuged to separate the plasma from the cells. >testing Ca added back clotting initiated and timed. |
| ANTICOAGULANTS - HEPARINized Plasma: | Heparinized Plasma is preferred over Serum for Potassium test because when blood clots, potassium is released from cells into the serum and can falsely elevate results. |
| ANTICOAGULANTS - HEPARIN: Additive in: | Green, Lt Green, Mottled Green/Gray, Royal Blue w/green Label, Green & Lt Green Microtubes, Red-banded & Green-banded Microhematricrit tubes |
| ANTICOAGULANTS - HEPARIN: 3 Formulations: | 1. Ammonium Heparin (can not be used when testing Ammonium levels) 2. Lithium Heparin (can not be used when testing Lithium levels) 3. Sodium Heparin (can not be used when testing Sodium levels) |
| ANTICOAGULANTS - HEPARIN: | >Lithium Heparin causes the least interferenc in Chemistry Testing. >Most used for plasma and whole-blood chemistry tests. |
| ANTICOAGULANTS - OXALATES: | Prevent coagulation by precipitating calcium. >Potassium Oxalate is the most widely used. >Added to tubes containing Glucose preservatives (Anticlycolytic Agents)to provide Plasma for Glucose testing. |
| ANTICOAGULANTS - OXALATES: Grey Stopper Tubes | Grey stopper tubes for Glucose testing, fasting glucose, GTT, Lactose... |
| ANTICOAGULANTS - OXALATES: | Must be mixed by inversion at collection to prevent clot formation and fibrin generation 8-10 times. |
| ANTICOAGULANTS - OXALATES: | Fill to volume state on tube - excess oxalate causes hemolysis of RBCs and releases hemoglobin into the plasma. |
| SPECIAL-USE ANTICOAGULANTS ACID CITRATE DEXTROSE (ACD) 2 Formulations (Solution A & B): | >For Immunohemological Testing >DNA Testing >Human Leukocyte Antigen (HLA) phenotyping ( |
| SPECIAL-USE ANTICOAGULANTS ACID CITRATE DEXTROSE (ACD): | >Acid Citrate prevents clotting by binding Ca with little effect on cells and platelets. >Dextrose acts as RBC nutrient, preservative maintaining RBC viability. |
| SPECIAL-USE ANTICOAGULANTS ACID CITRATE DEXTROSE (ACD):YELLOW TOP | Yellow Top ACD Tubes must be mixed after collection by inversions 8 times to prevent clotting. |
| SPECIAL-USE ANTICOAGULANTS CITRATE PHOSPHATE DEXTROSE (CPD): Blood Banking | Is used for collecting blood for Transfusion. |
| SPECIAL-USE ANTICOAGULANTS CITRATE PHOSPHATE DEXTROSE (CPD): | >Citrate prevents clotting by chelating Ca >Phosphate stabilizes pH >Dextrose provides nutrients for cells maintaining viability. |
| SPECIAL-USE ANTICOAGULANTS SODIUM POLYANETHOL SULFONATE (SPS): | It is used for blood culture collection >Reduces the action of protein called complement which destroys bacteria. >Slows Phagocytosis & reduces activity of antibiotics. >Prevents coagulation by binding Calcium. |
| SPECIAL-USE ANTICOAGULANTS SODIUM POLYANETHOL SULFONATE (SPS): Yellow Top | Must be mixed by inversion 8 times to prevent clotting. |
| ANTIGLYCOLYTIC AGENTS: | Prevents the metabolism of glucose (Glycolysis) by the blood cells. If metabolism not prevented glucose concentration decreases 10 mg/dL an Hour. Increased Glycolyis in Newborns due to increased metabolism. Leukemia patients do to WBC metabolism |
| ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE: | Is the most common antiglycolytic agent. It preserves glucose for up to 3 days and inhibits the growth of bacteria. |
| ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE combined with POTASSIUM OXALATE: | To provide specimens for rapid-response situations. |
| ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE: Gray Stopper | Require 5-10 inversions after collection for proper mixing. |
| ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE: ETOH Specimens | Used to collect Ethanol specimens to prevent either a decrease in alcohol concentration due to glycolysis or and increase due to fermentation by bacteria. |
| CLOT ACTIVATORS: | Enhance coagulation in tubes used to collect serum specimens. Clot activators include glass, (Silica) particles and inert clays like Celite and clotting factors such as Thrombin. Require 5 gentileinversions for mixing. |
| CLOT ACTIVATORS - SILICA: | >Particles provide more surface area. > Silica particle cause the blood to clot within 15-30 minutes. |
| CLOT ACTIVATORS - SILICA: | > Silica particle are the clot activators in Serum-Sepeartor Tubes SST and Plastic Red Top Tubes. |
| CLOT ACTIVATORS - CELITE: | Used in POCT coagulation systems. |
| CLOT ACTIVATORS - SST tubes | Blood in SST tube will eventually clot without mixing. If it is not mixed glass particle may become suspended in serum and interfere in the testing process. |
| CLOT ACTIVATORS - THROMBIN: | Blood collected in Thrombin Tubes usually clot within 5 minutes. |
| THIXOTROPIC GEL SEPARATOR: | >Is and inert (nonreacting) gel contained in the blood collection tube. >When centrifuged the gel is between he cells and the serum or plasma. >Gel separation keeps the cells from further metabolism. |
| THIXOTROPIC GEL SEPARATOR - SST: Gold Plastic | Serum Separator Tubes |
| THIXOTROPIC GEL SEPARATOR - with EDTA: PPT | Plasma Preparation Tubes |
| THIXOTROPIC GEL SEPARATOR - RST: Red/Gray rubber Stopper | Rapid Serum Separator Tubes contain Thrombin and clot in 5 minuts |
| THIXOTROPIC GEL SEPARATOR - Heparinized Plasma Gel Barrier Tubes: PST | Plasma Separator Tubes |
| TRACE ELEMENT-FREE TUBES: Royal Blue | Royal Blue: Normally indicate a Trace Element Free Tubes. They are free of any trace of contamination. |
| TRACE ELEMENT-FREE TUBES - EDTA, Heparin, or No Additive | Dependent on Testing required. |
| ORDER OF DRAW: | Order in which tubes are collected during a multiple tube draw or syringe. |
| ORDER OF DRAW ACCORDING TO CLSI: Requirements for ETS & Syringe: | 1. Sterile Tube (Blood Culture), 2. Blue Top Coagulation Tube, 3. Serum Tube w/wo clot activator or gel separator, 4. Heparin w/wo gel plasma separator, 5. EDTA tube, 6. Glycolytic inhibitor tube. |
| (1)ORDER OF DRAW - YELLOW SPS STERILE TUBE: | Prevents coagulation by binding Calcium. |
| (1)ORDER OF DRAW - YELLOW STERILE TUBE: | None |
| (2)ORDER OF DRAW - LT BLUE TUBE: Coagulation | Sodium Citrate Forms calcium salts to remove Calcium (PT & PTT) Full draw required and centrifugation. |
| (3)ORDER OF DRAW - RED GLASS NON-ADDITIVE TUBE: Chemistry, Immunology, Serology, and Blood Bank for Cross Match. | Blood clots and the serum is separated by centrifugation. |
| (3)ORDER OF DRAW - GOLD SST TUBE: Chemistry, Immunology, and Serology | Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation. |
| (4)ORDER OF DRAW - YELLOW ACD TUBE: Blood Banking, Immunology | Acid-citrate-dextrose Complement Activation. HLA tissue typing and DNA studies |
| (5)ORDER OF DRAW - LT GREEN PLASTIC PST TUBE: Chemistry | Plasma Separating Tube (PST) with Lithium Heparin. >Anticoagulates with Lithium heparin; Plasma is separated with the PST gel at the bottom of the tube. |
| (6)ORDER OF DRAW - GREEN HEPARIN TUBE: Chemistry | Sodium heparin, Ammoniam heparin or lithium heparin inactivates thrombin and Thromboplastin. For levels of lithium, sodium or Ammonia, can not use corresponding heparin"s must use others |
| (7)ORDER OF DRAW - LAVENDER EDTA TUBE: Hematology | Forms calcium salts to remove calcium 8-10 inversions to mix after collection. |
| (7)ORDER OF DRAW - PINK EDTA TUBE: Blood Bank | Forms calcium salts to remove calcium. Cross Match Requires full Draw. Invert 8-10 times to prevent clotting and platelet clumping |
| (9)ORDER OF DRAW - GRAY OXALATE/FLUORIDE TUBE: Chemistry | Sodium Fluoride and Potassium Oxalate antiglycolytic angents presreves glucose 3 days. May cause Hemolysis if draw is short. |
| CROSSOVER / CROSS CONTAMINATION: | Cross-contamination is the transfer of additive from one tube to the next. |
| CROSSOVER / CROSS CONTAMINATION: EDTA | EDTA in tubes has been the source of more carryover problems than any other additive. |
| CROSSOVER / CROSS CONTAMINATION: Heparin | Heparin causes the least amount of interference in tests other than Coagulation tests because it also occurs in blood naturally. |
| CROSSOVER / CROSS CONTAMINATION: How to avoid: | >Make sure fill tubes from bottom up during collection. >Tube contents does not come into contact with needle. >Or in transferring blood into tubes from syringe. |
| TISSUE THROMBOPLASTIN CONTAMINATION: | Thromboplastin is a substance present in tissue fluid activates the extrinsic coagulation pathway and can interfere with coagulation tests. |
| MICROBIAL CONTAMINATION: Blood Cultures | Clean Tops and Skin according to protocol. Skin Surface Friction scrub, top of BC cleaned with antispetic wipe. |
| ADDITIVES - LT BLUE Top: SODIUM CITRATE | DEPARTMENT: Coagulation |
| ADDITIVES - RED Top: NONE | DEPARTMENT: Chemistry, Blood Banking, Serology, and Immunology |
| ADDITIVES - RED Top: CLOT ACTIVATOR | DEPARTMENT: Chemistry |
| ADDITIVES - RED/LT GRAY clear Top : NONE | NA Discard Tube Only |
| ADDITIVES - RED/BLACK (TIGER) Top: CLOT ACTIVATOR & GEL SEPEARTOR | DEPARTMENT: Chemistry |
| ADDITIVES - RED/GOLD (TIGER) Top: CLOT ACTIVATOR & GEL SEPEARTOR | DEPARTMENT: Chemistry |
| ADDITIVES - GREEN/GRAY Top: LITHIUM HEPARIN AND GEL SEPARATOR | DEPARTMENT: Chemistry |
| ADDITIVES - lT GREEN Top: LITHIUM HEPARIN AND GEL SEPARATOR | DEPARTMENT: Chemistry |
| ADDITIVES - GREEN Top: LITHIUM HEPARIN | DEPARTMENT: Chemistry |
| ADDITIVES - GREEN Top: SODIUM HEPARIN | DEPARTMENT: Chemistry Lt Brown Top (Serum lead determination) |
| ADDITIVES - GREEN Top: AMMONIUM HEPARIN | DEPARTMENT: Chemistry |
| ADDITIVES - LAVENDER (PURPLE)Top: EDTA | DEPARTMENT: Hematology |
| ADDITIVES - PINK Top: EDTA | DEPARTMENT: Blood Bank |
| ADDITIVES - GRAY Top: SODIUM FLUORIDE & POTASSIUM OXALATE | DEPARTMENT: Chemistry |
| ADDITIVES - GRAY Top: SODIUM FLUORIDE & EDTA | DEPARTMENT: Chemistry |
| ADDITIVES - GRAY Top: SODIUM FLUORIDE | DEPARTMENT: Chemistry |
| ADDITIVES - ORANGE Top: THROMBIN | DEPARTMENT: Chemistry Orange Top Tube |
| ADDITIVES - GRAY/YELLOW Top: THROMBIN | DEPARTMENT: Chemistry |
| ADDITIVES - ROYAL BLUE Top: NONE | DEPARTMENT: Chemistry |
| ADDITIVES - ROYAL BLUE Top: EDTA | DEPARTMENT: Chemistry |
| ADDITIVES - ROYAL BLUE Top: SODIUM HEPARIN | DEPARTMENT: Chemistry |
| ADDITIVES - TAN Top: EDTA | DEPARTMENT: Chemistry |
| ADDITIVES - YELLOW Top: SODIUM POLYANETHOL SULFONATE (SPS) | DEPARTMENT: Microbiology |
| ADDITIVES - YELLOW Top: ACID CITRATE DEXTROSE (ACD) | DEPARTMENT: Blood Banking, Immunology |
Created by:
jlmillington1
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