Comparison of BD Vacutainer® Rapid Serum Tube and plasma for haemolysis markers in the emergency department

Abstract

Background: In recent years, a rapid-clotting serum tube, BD Vacutainer Õ Rapid Serum Tube (RST TM ), was introduced to improve turn-around times for serum samples. Previous studies reported reduced concentrations of some markers of haemolysis in RST specimens compared to other serum or plasma samples. We aimed to compare RST to plasma tubes for haemolysis markers in an emergency department (ED) setting, where increased rates of haemolysis are commonly seen. Methods: Patients presenting to ED over an eight-day period had an RST, BD Vacutainer Õ PST TM II (plasma) Tube and BD Vacutainer Õ Heparin (non-gel, plasma) Tube collected. Blood was drawn from an intravenous cannula, and samples were promptly analysed for haemolysis index, potassium, phosphate, aspartate aminotrasferase (AST), magnesium and lactate dehydrogenase (LD). Results: A total of 347 patient samples were included, and 9.2% of the PST samples were haemolysed. The RST tubes had small increases in all of the haemolysis markers compared to both plasma tubes (P 4 0.005), except LD which was lower in the RST group. There were no significant differences in the proportion of results above the upper reference limit between the tubes, except for LD which had a lower proportion in RST samples (P 4 0.002). Conclusion: Compared to plasma, RST specimens show small increases in several haemolysis markers, consistent with known differences between serum and plasma, but the proportion of elevated haemolysis markers is similar to plasma. In a setting with a high haemolysis rate such as ED, RST specimens provide a non-inferior sample type for markers of haemolysis.

Improved quality of samples and laboratory turnaround time using 3.5 mL low vacuum BD Vacutainer® Barricor tubes in the emergency department

“…Several studies evaluated factors attributed to the hemolysis of blood samples particularly from ED. Causes and nature of hemolytic specimen are multiple [5] but the collection techniques in the ED appeared to be the origin of the increased hemolysis rate problem [12,13]. Recently, Phelan study confirmed previous findings that straight stick and antecubital location are significantly associated with reduced hemolysis and indicated that shorter tourniquet time and larger gauge for IV draws were significantly associated with lower hemolysis [14].…”

Evaluation of the quick-clotting serum separator tube, VQ-Tube™, for clinical chemistry and thyroid hormone assays

“…Fast clot activation results in the more rapid separation of blood cells from serum. 2 Although serum glucose concentrations tend to be high in quick-clotting tubes than SSTs, 10,12,18 it is measured at a lower concentration than in lithium heparin tube and gold standard. 19 In addition, blood collection tubes containing clot activator and lithium heparin are not suitable for glucose measurement; 9,20 the use of VQ-tube alone should be avoided in order to accurately measure glucose concentrations.…”

“…Previously reported studies suggested that shortened clotting time contributed bias to serum glucose as well as LD concentration between the tubes. 2,21 Differences in concentrations of LD are frequently reported 10–12,18 in rapid clotting serum tubes compared with general SSTs. Zhang et al.…”

“…However, several factors need to be considered to improve the performance of SSTs. Latent clotting was observed in the blood of patients taking high-dose anticoagulant therapy, 10 and reduced lactate dehydrogenase (LD) concentrations 10–12 have been reported.…”

Comparison of Abbott Architect high-sensitivity troponin I in Rapid Serum Tubes and plasma

“…For the comparison statistics, results below the assay limit of detection (1.9 ng/L) were assigned that value. Details of the sample collection can be found in [6].…”