Specimen Management

More on Polycythemia and Anticoagulant Volume

More on anticoagulant adjustment from Heather DeVries: There is more to our story on adjusting sodium citrate for high hematocrits. We have a pediatric patient who is getting multiple draws, for multiple assays, throughout the day. Sometimes there is PT and/or PTT, but sometimes not. The techs are confused as to when the draw must […]

Specimen Management

Polycythemia and Anticoagulant Volume

From Heather DeVries, Indiana University Health: Greetings George! A couple of sites within our system are evaluating our process for correcting tubes. One mentioned CLSI guidelines, and when I looked, they keep it very simple, saying that removal of 0.1 mL of citrate will cover hematocrits between 55 and 65%. Historically, we have calculated to […]

Specimen Management

Short Draws

This 12/23/16 “short draw” question from Adam McMullen is copied from MEDLAB-L, hosted by Pat LeTendre. Adam and Pat have granted permission for its reproduction here. Hello, We use BD Vacutainer® 2.7 mL for routine coagulation testing–PT/INR, PTT, and fibrinogen. These tubes provide a minimum fill line. Our policy requires we adhere to this line, […]

Specimen Management

Specimen Hemolysis Quick Question

We’ve closed our November, 2016 Quick Question, “How do you manage hemostasis specimens with visible hemolysis?” Here are your answers: It all depends, please see my comment: 14 respondents, 18% Discard specimen and notify the patient or caregiver: 27 respondents, 37% Perform the requested assay and append a comment: 17 respondents, 23% Perform the assay […]

Quick Question Archive

ED Specimen Hemolysis

George has been corresponding with friend and colleague, Dennis Ernst, MT (ASCP), Director, Center for Phlebotomy Education about the prevalence of hemolyzed specimens from the Emergency Department (ED) compared to hemolysis rates from other units. Dennis and George agree hemolysis is related to the practice of collecting laboratory blood specimens at the time the nurse […]

Specimen Management

Collect Specimens After Dialysis

Here is a question from colleague, friend, and frequent contributor Larry Brace, PhD, Edward Hospital, Naperville, IL: Our (years-old) phlebotomy policy says to wait 4 hours after dialysis before venipuncture unless a doctor approves the draw. It makes sense but we can’t seem to find a reference. Can you suggest any? Also, is this policy pretty […]

Anticoagulant Therapy

Platelet Clumps in Citrate Tube

Dear Fritsma Factor, I am a hematopathology fellow evaluating the following patient for thrombocytopenia. History and laboratory results are listed in detail below. We have encountered a situation where the patient develops platelet clumps within citrate tubes but not in EDTA. I have found only limited information regarding this phenomenon and was wondering if anyone […]

Bleeding Disorders

Specimens with Hematocrit >55% Reprise

On September 12, 2016, Michelle Fahs MT (ASCP) asked about how to prepare tubes with the proper volume of anticoagulant for people whose hematocrit exceeds 55%. Here is a question from Sandy Odegaard asking about the correction formula’s derivation: Hi George, BD could not explain where the conversion factor for calculating the appropriate sodium citrate […]

Specimen Management

Correction Factor for ACD Solution

On September 28, 2016, Julia Hill asked, “Is there a standard calculation for using ACD tubes?” Her comment was appended to a 2009 entry describing HELLP syndrome, so it may have been buried deep in our database. George assumes Julia’s question relates to platelet satellitosis, which results from the action of an immunoglobulin potentiated in […]

Platelet Function Testing

Acceptable Coagulation Test Specimens

From Lauren Ball: Do you suggest that most labs use a 4 hour rule for specimen acceptability? We offer PT, PTT, fibrinogen, D-dimer, and anti-Xa tests. PTTs and Anti-Xa tests may need to be performed within 2 hours but the manufacturer’s guidelines suggest that a specimen is good for up to 8 hours for tests […]

Specimen Management

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George Fritsma is a medical laboratory scientist, educator, and author. George holds faculty appointments with Rutgers University and Michigan State University, and is a member of the International Society on Thrombosis and Hemostasis, American Association of Clinical Chemists, and American Society for Clinical Laboratory Science.

Cheat Sheets from George

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