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Special Specimen Collection and Handling

SPECIFIC COLLECTION GUIDELINE—HEMOSTASIS/THROMBOSIS SPECIMENS

To produce valid results for hemostasis/thrombosis tests and factor assays, specimen integrity is crucial and must be maintained. All specimens sent for testing must be collected and shipped in the following manner:

• Obtain venous blood by clean venipuncture. Avoid slow flowing draws and/or traumatic venipunctures as either of these may result in an activated or clotted specimen. Do not use needles smaller than 23 gauge. Do not leave the tourniquet on for an extended length of time before drawing the sample.
• Draw a pilot tube (non-additive or light blue tube), as a recommended procedure, before drawing coagulation specimens in light blue-top vacuum tubes (3.2% buffered sodium citrate). Discard the pilot tube.
  Note: Reference intervals have been established using 3.2% buffered sodium citrate.
• Fill light blue-top tubes as far as vacuum will allow and mix by gentle inversion. Exact ratio of nine parts blood to one part anticoagulant must be maintained. Inadequate filling of the sample tube will alter this ratio and may lead to inaccurate results. Patients who have hematocrit values above 55% should have the anticoagulant adjusted to maintain the 9:1 ratio. Use the following formula to determine the amount of anticoagulant to use: [(100 – Hct) / (595 – Hct) ]* total volume = amount of anticoagulant required.
• Centrifuge the specimen at 1700 x g for 15 minutes (or at a speed and time required to consistently produce platelet-poor plasma—platelet count less than 10,000/μL). Hemolyzed specimens will be rejected.
• Immediately remove only the top two-thirds of the platelet-poor plasma from the specimen using a plastic transfer pipet (use of glass transfer pipets may result in activation and/or clotting of the plasma). Place the plasma in a properly labeled ARUP Standard Transport Tube and clearly mark the vial contents as PLASMA. Glass vials will be rejected.
• Immediately freeze the plasma in a non-frostfree freezer. Samples may be stored at -20°C for two weeks or preferably at -70°C. Specimens must remain frozen during storage and shipment. A separate ARUP Standard Transport tube must be submitted for each assay requested.
• All requests for coagulation assays should include a brief patient history and other pertinent clinical information (e.g., medications, blood products, etc.).
  Note: Specimens containing heparin should not be used for coagulation studies. If possible, stop heparin therapy before the draw to avoid contamination. Heparin interferes with most clotting assays.
• Coagulation consultation is available. Contact the Hemostasis/Thrombosis Laboratory at (800) 242-2787, extension 2151, for information.