From Donna Kaiser, St. Joseph Health System: I was wondering if you have any information on using acid citrate dextrose (ACD) tubes for EDTA platelet clumpers. I have heard they may work better than the sodium citrate tubes especially for oncology patients. If so, are Sol A or Sol B tubes being used and is there a dilution factor. Thanks.
Hi, Donna, and thank you for your question. I have attached an article, Criswell KA, Breider MA, Bleavins MR. EDTA-dependent platelet phagocytosis: a cytochemical, ultrastructural, and functional characterization. Am J Clin Pathol 2001;115:376–84, in which the investigators conclude that ACD prevents platelet satellitosis. Another article reports on a 1988 study performed in The Netherlands, Lombarts AJ, de Kieviet W. Recognition and prevention of pseudothrombocytopenia and concomitant pseudoleukocytosis. Am J Clin Pathol 1988;89:634–9. The investigators added a volume of the ACD solution prepared for banked blood and indicated that it prevents satellitosis. Neither addresses the need to adjust for a dilution effect and neither addresses whether the ACD specimen can be used to produce valid CBC results. Becton-Dickinson only recommends substituting sodium citrate tubes for EDTA tubes, although I have also used heparinized tubes.
BD’s two ACD formulations differ markedly. Sol A is comprised of 22 g/L trisodium citrate, 8 g/L citric acid, and 24.5 g/L dextrose. Sol B is made up of 13.2 g/L trisodium citrate, 4.8 g/L citric acid, and 14.7 g/L dextrose. I suspect the different concentrations reflect anticipated specimen volume. The only BD tube using Sol A is their 8.5 mL tube, their 3 and 6 mL tubes use Sol B. You’d probably select the smaller tube for practical considerations. BD’s description of the tube application is for immunohematology, cytometry, and molecular studies, but they offer no in-depth information.
I hope that some of our participants have experience with the ACD tube, but while we wait for comments, I suggest that you collect data on the ACD tube in satellitosis compared to sodium citrate. This could be a useful Clinical Practice study for the Clinical Laboratory Science journal!