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Guidelines for collecting, preparing, and transporting specimens to ensure accurate test results in clinical laboratories. It covers different types of specimen containers, their uses, and preparation procedures for serum, whole blood, plasma, and coagulation studies. It also discusses common causes of unacceptable specimens, such as hemolysis, lipemia, and incorrect specimen type.
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The accuracy of any test result depends on the quality of the specimen submitted. Following the collection, preparation and transport instructions will help to ensure the most accurate test results.
Prior to collecting the specimen, review the specimen requirements listed in the test listing section of this manual. Note the proper specimen type to be collected, amount of sample necessary for testing and special storage and/or transport instructions. Each specimen container should be properly identified with the patient’s full name, date, time of collection and specimen type. Each specimen must be accompanied by a properly completed test requisition.
Red Top: Does not contain an anticoagulant. This tube is used for collecting serum or clotted whole blood specimens. This tube should be used for all drug levels. Serum Separator Tube (SST) (Tiger Top): Does not contain an anticoagulant but contains a clot activator and serum separator gel. This tube is used for collecting serum. Light Blue: Contains the anticoagulant sodium citrate. This tube is used for preparing citrated plasma for coagulation studies. Tube should be inverted 8-10 times immediately after collection to prevent clotting. It is also important to completely fill the tube to the appropriate level since the ratio of blood to anticoagulant is critical for coagulation tests. Green (Sodium or Lithium Heparin): Contains the anticoagulant sodium heparin or lithium heparin. This tube is used for preparing heparinized plasma, whole blood, or bone marrow specimens. Tube should be inverted 8-10 times after collection to prevent clotting. Lavender (EDTA): Contains the anticoagulant EDTA. This tube is used for preparing EDTA plasma, whole blood, or bone marrow specimens. Tube should be inverted 8- 10 times after collection to prevent clotting. Royal Blue: May contain either the anticoagulant EDTA or no anticoagulant. The tube containing anticoagulant is used for preparing whole blood or plasma trace element studies and the tube without anticoagulant is used for preparing serum trace element studies. Yellow: Contains the anticoagulant acid citrate dextrose (ACD). This tube is used for preparing whole blood specimens used for special studies. Gray: Contains the preservative sodium fluoride and the anticoagulant potassium oxalate. This tube is used for preparing whole blood and plasma specimens such as glucose testing or blood alcohol testing.
Serum: Collect whole blood in an amount 2 ½ times the required volume of serum so that a sufficient amount of serum can be obtained. To obtain serum, whole blood should be collected into either an SST or plain red top tube. After collection, allow the tube to sit in an upright position at room temperature for 30-45 minutes. After the clot has formed, centrifuge the tube for 10 minutes at 3400 rpm. Remove the tube and transfer the serum to a transport tube and store specimen as required. Whole Blood: Collect whole blood in the collection tube specified for the test. To avoid clotting, invert tube 8-10 times to mix the blood with the anticoagulant. Never freeze whole blood unless specifically instructed in the specimen requirements. Plasma: Collect blood in the collection tube specified for the test. Invert tube 8-10 times to ensure proper distribution of anticoagulant. Specimens collected in additive tubes for plasma may be centrifuged immediately. Centrifuge the tube for 10 minutes at 3400 rpm. Remove the tube carefully without disturbing the contents. Using a pipette, carefully transfer the plasma to a plastic tube taking care not to transfer any cellular material. Store the specimen as required. Coagulation/Hemostasis: To produce valid results for coagulation tests and factor assays, specimen integrity is crucial and must be maintained. All specimens sent for testing must be collected in the following manner:
Quantity Not Sufficient (QNS): QNS means that the specimen volume received for testing was not enough to meet the minimum volume required to perform the test at least once. The minimum specimen volume is the amount required to perform the test only once. Please refer to the test requirements for specimen volumes. Plasma Specimen Errors: Plasma contains fibrinogen and other clotting factors when separated from the red blood cells. The most common errors in the preparation of plasma include: