This message came to George via Elaine Benoit, Precision BioLogic Inc. Good evening Mr George, I accidentally came across the site and I am very happy to have found you. First of all I apologize for English. I am passionate about in vitro haemostasis. In December 2013 I thought and applied a post-analytical sample clotting procedure that we are using at this time, being effective. We have never used an applicator on the real reason that before centrifuging we are not allowed to "look" in the sample. And then it's relative to find the little clot that can not get caught by the applicator. I would feel honored to join you to share this procedure, as well as the reasoning of your need. With great respect, Carmen Delianu.
Hello, Dr. Delianu, and thank you for your question and your offer to share your procedure. For assistance, I forwarded your question to my colleague and friend, Dennis Ernst, Center for Phlebotomy Education. Here is Dennis's response:
If I understand it correctly, Carmen Delianu is wanting us to suggest a procedure on removing clots from tubes without an applicator stick. I agree with Carmen that using an applicator is a bad idea for many reasons. However, I think the only substitute is to prevent the conditions that make it necessary to remove a clot in the first place. Of course, the presence of clots in a coag tube render the sample unusable for testing, so it's pointless to take them out.
The conditions that cause clots to form in coag tubes include overfilling, inadequate mixing, allowing blood to remain in a syringe too long before transferring, and using expired tubes. There may be more, but those are the ones that come to mind. If we took an educational approach to teach our staff about these causes, we'd probably have fewer clots and better samples. So I think the only real answer is to be proactive to prevent clots in the first place. Taking a reactive approach to remove the clot is inadvisable.
To expand on Dennis's comment, my institution discontinued the use of applicator sticks to check for clots several years ago, mainly because the process introduced the risk of viral transmission through exposure to blood. In addition, our test volume precludes the possibility, it would slow our processing drastically. Also, two years ago we moved to automation, which makes it almost impossible to check every specimen. We make every effort, as Dennis recommends, to educate our blood collectors on proper specimen management technique, and in addition, we review any suspicious coagulation test results. I hope this is helpful.