From Diane Belliveau, Catholic Medical Center, Manchester, New Hampshire: Hi George, we have a special care nursury. I am looking for help in specimen handling/volumes for these special patients. Are there any new products for coagulation specimen collections on babies?
Hi, Diane, the only 3.2% sodium citrate tube available for low-volume collection, 1 mL, is the Greiner Bio-one MiniCollect® tube, catalogue number 450413. The description, however, carries this notation, “MiniCollect Coagulation Tubes are for use with venous blood only.” There appear to be no capillary collection devices for coagulation.
If any participant has a recommendation for collection from newborns, please comment below.
We noticed a significant variation in aPTT results for patie
We noticed a significant variation in aPTT results for patients in our hospital using the BD 1.8 mL sodium citrate Vacutainers. Patients were drawn using the standard 2.7 mL and the 1.8 mL tubes (both tubes from the same phlebotomy) and the PT, PTT and fibrinogen results were compared. We found that the PTs were all comparable, but there were significant differences for PTTs and fibrinogens. In some cases, a patient’s PTT result changed from therapeutic for heparin to subtherapeutic. Patients with high fibrinogens also showed more variability than we were comfortable with. We are still trying to find a satisfactory tube for pediatric patients and other patients where blood draw volume is an issue.
Word of caution–we were using a commercial small volume col
Word of caution–we were using a commercial small volume collection tube with apparently same sodium citrate concentration as usual source (B&D). On limited testing with a new batch we found a significant variation in INR values (>0.5) between systems within the therapeutic range, hence we no longer use this tube supply. We now locally manufacture small volume tubes (using sodium citrate from the BD tube) or use smaller draw tube available.
We are using the BD 1.8ml vacutainer for our spec
We are using the BD 1.8ml vacutainer for our special care nursery and difficult pediatric draws. We also will offer the neonatal providers a test called “PTT Hepzyme reflex” where we will perform the heparin neutralization on all abnormal samples on neonates, since they often are line collections and wasting sample isn’t feasible.