ASCP Review for Blood Collection Additives
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CAUTION: Never transfer blood collected in an additive tube into another additive tube. | show 🗑
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Blood Collection Additives: | show 🗑
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Additives are available in: | show 🗑
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Tube Inversion: | show 🗑
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Caution: Never Shake or Vigorously mix Tubes | show 🗑
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show | Are substances that prevent blood from clotting (coagulating)
>Must be mixed immediately after collection to prevent microclot formation.
>Gentle mixing prevents Hemolysis.
>Separate naturally or if centrifuged.
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ANTICOAGULANTS - Two Methods: | show 🗑
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ANTICOAGULANTS - Used for: | show 🗑
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show | >Available as a powdered di-potassium K2
>Available as a liquid tri-potassium K3 salt
>Prevents coagulation by binding (chelating) calcium
>Lavender, Purple, Pink, Pearl, Gray and Royal Blue top tubes
>Must be mixed by inversion immediately 8-10times
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show | >Purple or Lavender top tubes for Hematology
>Pink top tube for Blood Bank ( with special Blood Bank patient ID label & wrist band.
>CLSI Recommends using Spray Dried EDTA to avoid dilution lowering Hemoglobin, RBC, WBC, Platelets and packed cell volum
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show | >Gray top for Chemistry (Glucose testing)
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show | >Royal Blue with Lavender Label for Chemistry
>Pearl top with Thixotropic gel separator for Plasma Preparation Tubes (PPT) for
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ANTICOAGULANTS - EDTA - Hematology & Blood Banking | show 🗑
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ANTICOAGULANTS - CITRATES: Lt Blue Stopper | show 🗑
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ANTICOAGULANTS - CITRATE: ESR | show 🗑
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show | To avoid microclotting citrates must be mixed by inversion 3-4 times after collection
>vigorous mixing can activate platelets and shorten clotting time giving erroneous results.
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ANTICOAGULANTS - CITRATES: 9:1 ratio | show 🗑
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show | Coagulation tests are performed on Plasma, so specimens must first be centrifuged to separate the plasma from the cells.
>testing Ca added back clotting initiated and timed.
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show | Heparinized Plasma is preferred over Serum for Potassium test because when blood clots, potassium is released from cells into the serum and can falsely elevate results.
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ANTICOAGULANTS - HEPARIN: Additive in: | show 🗑
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ANTICOAGULANTS - HEPARIN: 3 Formulations: | show 🗑
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show | >Lithium Heparin causes the least interferenc in Chemistry Testing.
>Most used for plasma and whole-blood chemistry tests.
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show | Prevent coagulation by precipitating calcium.
>Potassium Oxalate is the most widely used.
>Added to tubes containing Glucose preservatives (Anticlycolytic Agents)to provide Plasma for Glucose testing.
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ANTICOAGULANTS - OXALATES: Grey Stopper Tubes | show 🗑
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ANTICOAGULANTS - OXALATES: | show 🗑
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show | Fill to volume state on tube - excess oxalate causes hemolysis of RBCs and releases hemoglobin into the plasma.
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show | >For Immunohemological Testing
>DNA Testing
>Human Leukocyte Antigen (HLA) phenotyping (
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SPECIAL-USE ANTICOAGULANTS ACID CITRATE DEXTROSE (ACD): | show 🗑
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show | Yellow Top ACD Tubes must be mixed after collection by inversions 8 times to prevent clotting.
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SPECIAL-USE ANTICOAGULANTS CITRATE PHOSPHATE DEXTROSE (CPD): Blood Banking | show 🗑
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SPECIAL-USE ANTICOAGULANTS CITRATE PHOSPHATE DEXTROSE (CPD): | show 🗑
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show | It is used for blood culture collection
>Reduces the action of protein called complement which destroys bacteria.
>Slows Phagocytosis & reduces activity of antibiotics.
>Prevents coagulation by binding Calcium.
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SPECIAL-USE ANTICOAGULANTS SODIUM POLYANETHOL SULFONATE (SPS): Yellow Top | show 🗑
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ANTIGLYCOLYTIC AGENTS: | show 🗑
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show | Is the most common antiglycolytic agent. It preserves glucose for up to 3 days and inhibits the growth of bacteria.
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ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE combined with POTASSIUM OXALATE: | show 🗑
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ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE: Gray Stopper | show 🗑
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ANTIGLYCOLYTIC AGENTS - SODIUM FLUORIDE: ETOH Specimens | show 🗑
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show | Enhance coagulation in tubes used to collect serum specimens. Clot activators include glass, (Silica) particles and inert clays like Celite and clotting factors such as Thrombin. Require 5 gentileinversions for mixing.
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show | >Particles provide more surface area.
> Silica particle cause the blood to clot within 15-30 minutes.
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show | > Silica particle are the clot activators in Serum-Sepeartor Tubes SST and Plastic Red Top Tubes.
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CLOT ACTIVATORS - CELITE: | show 🗑
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CLOT ACTIVATORS - SST tubes | show 🗑
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show | Blood collected in Thrombin Tubes usually clot within 5 minutes.
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show | >Is and inert (nonreacting) gel contained in the blood collection tube.
>When centrifuged the gel is between he cells and the serum or plasma.
>Gel separation keeps the cells from further metabolism.
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THIXOTROPIC GEL SEPARATOR - SST: Gold Plastic | show 🗑
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THIXOTROPIC GEL SEPARATOR - with EDTA: PPT | show 🗑
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show | Rapid Serum Separator Tubes contain Thrombin and clot in 5 minuts
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THIXOTROPIC GEL SEPARATOR - Heparinized Plasma Gel Barrier Tubes: PST | show 🗑
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show | Royal Blue: Normally indicate a Trace Element Free Tubes. They are free of any trace of contamination.
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TRACE ELEMENT-FREE TUBES - EDTA, Heparin, or No Additive | show 🗑
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ORDER OF DRAW: | show 🗑
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show | 1. Sterile Tube (Blood Culture), 2. Blue Top Coagulation Tube, 3. Serum Tube w/wo clot activator or gel separator, 4. Heparin w/wo gel plasma separator, 5. EDTA tube, 6. Glycolytic inhibitor tube.
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(1)ORDER OF DRAW - YELLOW SPS STERILE TUBE: | show 🗑
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show | None
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(2)ORDER OF DRAW - LT BLUE TUBE: Coagulation | show 🗑
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show | Blood clots and the serum is separated by centrifugation.
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show | Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation.
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show | Acid-citrate-dextrose Complement Activation. HLA tissue typing and DNA studies
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show | Plasma Separating Tube (PST) with Lithium Heparin.
>Anticoagulates with Lithium heparin; Plasma is separated with the PST gel at the bottom of the tube.
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show | Sodium heparin, Ammoniam heparin or lithium heparin inactivates thrombin and Thromboplastin. For levels of lithium, sodium or Ammonia, can not use corresponding heparin"s must use others
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(7)ORDER OF DRAW - LAVENDER EDTA TUBE: Hematology | show 🗑
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(7)ORDER OF DRAW - PINK EDTA TUBE: Blood Bank | show 🗑
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show | Sodium Fluoride and Potassium Oxalate antiglycolytic angents presreves glucose 3 days. May cause Hemolysis if draw is short.
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show | Cross-contamination is the transfer of additive from one tube to the next.
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show | EDTA in tubes has been the source of more carryover problems than any other additive.
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CROSSOVER / CROSS CONTAMINATION: Heparin | show 🗑
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show | >Make sure fill tubes from bottom up during collection.
>Tube contents does not come into contact with needle.
>Or in transferring blood into tubes from syringe.
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show | Thromboplastin is a substance present in tissue fluid activates the extrinsic coagulation pathway and can interfere with coagulation tests.
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MICROBIAL CONTAMINATION: Blood Cultures | show 🗑
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show | DEPARTMENT: Coagulation
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show | DEPARTMENT: Chemistry, Blood Banking, Serology, and Immunology
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show | DEPARTMENT: Chemistry
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show | NA Discard Tube Only
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show | DEPARTMENT: Chemistry
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ADDITIVES - RED/GOLD (TIGER) Top: CLOT ACTIVATOR & GEL SEPEARTOR | show 🗑
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show | DEPARTMENT: Chemistry
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show | DEPARTMENT: Chemistry
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show | DEPARTMENT: Chemistry
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ADDITIVES - GREEN Top: SODIUM HEPARIN | show 🗑
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ADDITIVES - GREEN Top: AMMONIUM HEPARIN | show 🗑
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ADDITIVES - LAVENDER (PURPLE)Top: EDTA | show 🗑
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show | DEPARTMENT: Blood Bank
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show | DEPARTMENT: Chemistry
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ADDITIVES - GRAY Top: SODIUM FLUORIDE & EDTA | show 🗑
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ADDITIVES - GRAY Top: SODIUM FLUORIDE | show 🗑
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show | DEPARTMENT: Chemistry
Orange Top Tube
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ADDITIVES - GRAY/YELLOW Top: THROMBIN | show 🗑
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show | DEPARTMENT: Chemistry
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show | DEPARTMENT: Chemistry
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ADDITIVES - ROYAL BLUE Top: SODIUM HEPARIN | show 🗑
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ADDITIVES - TAN Top: EDTA | show 🗑
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ADDITIVES - YELLOW Top: SODIUM POLYANETHOL SULFONATE (SPS) | show 🗑
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ADDITIVES - YELLOW Top: ACID CITRATE DEXTROSE (ACD) | show 🗑
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