Specimen Management

Tube System and Heparin

The subject of tube system hemostasis specimen delivery originally appeared on theMedlab_L list, and I asked Linda Stang, Lab Scientist in Special Coagulation at theUniversity of Alberta Hospital in Edmonton for permission to share her Medlab_Lcomment. She wrote, “Our hemolysis rate for those patients is much higher and we are engaging in a plan to figure it out. The […]

Specimen Management

Specimen Tube “Head Space” and pH

A colleague asked about an issue with “head space” and surface area in sodium citrate (blue-closure) tubes causing changes in pH with the changes becoming more profound the longer the tube is stored. This then affects test results. My friend had not heard of this before although he knows there are pH changes associated with […]

Specimen Management

BD Recalls Citrate Tubes

From Kelly Townsend at Tricore Reference Laboratories in Albuquerque: Just got a letter stating that BD Vacutainer is recalling a lot of their 2.7 mL sodium citrate tubes due to lithium heparin contamination. Has anyone seen issues with this and how are folks investigating? Thanks.

Specimen Management

Delta Checks for PT, PTT, Fg, and D-dimer

Lisa Ledford at Duncan Regional Hospital asks, Would you be willing to share your δ-check values for PT/INR, PTT, fibrinogen, and D-dimer? Hi, Lisa, I checked with Warren Varden at UAB, who confirmed that we don’t use delta checks. Our special coagulation staff carefully review results and communicate with our inpatient and outpatient units. They are able to discern when there […]

Specimen Management

Does In Vivo Citrate Affect PT or PTT?

From Madan Verma: Hi George. I am wondering if there are any correlation studies about whether switching hemodialysis patients from heparin to 4% sodium citrate will affect the prothrombin time (PT) or partial thromboplastin time (PTT). Thank you. Hello, Madan Verma, and thank you for your patience. I found over 500 PubMed references, most of which […]

Screening Assays

Reduce Blue-top Tube Volume?

From Maria E. Martinez. Is anyone re-adjusting anticoagulant levels in blue tops? We atOrlando Health have a large NICU and collecting a 2 mL blue top sometimes can be a huge demand. I have heard of re-adjusting the 200 uL anticoagulant in the 2 mL blue top to 100 uL and instructing the nurse to draw up […]

Specimen Management

Preparing PPP

From Rebecca Jones, Trinity Medical Center, Birmingham: Hey George, love the website! If only all disciplines had access to all this knowledge! Thanks for all you do. I have another question for you to ponder…or not. What is your feeling about performing a “hard spin” on coagulation specimens? We do a “quick spin” for 2–3 minutes […]

Specimen Management

PT & PTT on a Lipemic Specimen

From Janice Stringfield, Jennie Stuart Medical Center, Hopkinsville, KY: We have an extremely lipemic specimen that we have a prothrombin time (PT) and activated partial thromboplastin time (APTT, PTT) ordered on from the ED. How do you get a result? We can’t find anyone that does a mechanical method anymore. Do you have any suggestions? Hi, Janice, […]

Specimen Management

Specimen Management in Fibrinolysis

I had the opportunity to become reacquainted with Jennifer Jacobsen, MLS (ASCP),Allina Health Laboratories, Minneapolis, while attending the Mayo Laboratories Coagulation Testing Quality conference in Rochester, Minnesota August 7–10. Jennifer has this question about specimen management on patients being treated with tissue plasminogen activator (TPA, Activase®, Alteplase®): George, both the prescribing information for Alteplase and Stago’s fibrinogen reagent package […]

D-dimer: Double-spin?

Hi George. Why is it not important to double-spin D-dimer specimens for platelet poor plasma (PPP) when there’s a delay in testing? Is this because D-dimers are not affected by labile factors as other coag testing? Looking forward to your answer. Teresa Lovejoy, MT (ASCP) Senior Medical Technologist, Hematology Children’s of Alabama. Birmingham, AL Hi, […]

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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.

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