Specimen Collection Manual and Test Catalog

Eight (8) 1 mL plasma aliquots AND (1) 0.5 mL serum 
Collect four (4) 2.7 mL blue-top tubes (3.2% sodium citrate) AND one (1) 3.5 mL gold-top (serum separator) tube.

• If the patient’s hematocrit (HCT) is >55%, the volume of anticoagulant in the tube should be adjusted. Contact a performing location for special tube preparation to reduce the citrate in the collection tube. For those patients with HCT >65.4% see LAB3632 Stago Sodium Citrate Adjustment Chart for formula to determine amount of citrate removal required.
• When possible, use fresh venipuncture to collect blood to avoid activation of coagulation by tissue thromboplastin. Blood may be drawn from an indwelling catheter or vascular access device. Draw sample from a lumen that has not been heparinized or flush the line with 5 ml of saline, and discard the first 10 mL of blood.
• Tubes should be >90% filled.
• Immediately mix gently after collection by inverting the tube end over end 5 to 6 times. Avoid vigorous mixing or additional inversion. Observe for the presence of clots. Recollect if fibrin clots observed.
• Transport at ambient temperature to processing location and processing should be completed within 4 hours.
• Butterfly device collections, draw a discard tube first to remove air from collection tubing.

Thrombosis testing immediately after a thrombotic event is discouraged. Patient should be off all anticoagulation prior to collection as follows:
Heparin- 48 hours 
Coumadin - 2 weeks 
Direct thrombin or Xa inhibitors - 7 days
Anti-platelet medication- no need to stop

Centrifuge blue top specimens immediately at designated time and speed to obtain platelet-poor plasma (<10,000/µL). Using a plastic pipette, carefully remove plasma from cells, avoiding platelet/buffy layer by leaving a thin layer of plasma on top the cells. The centrifuged plasma should be aliquoted (1 mL per aliquot) into clearly labeled polypropylene tubes. Eight (8) plasma aliquots needed. Check the residual specimen for clot and if present discard sample and redraw specimen. Freeze upright and transport on dry ice.

Allow serum to clot. Centrifuge and submit 0.5 mL serum.

Eight (8) aliquots of citrated plasma frozen, one (1) aliquot of serum refrigerated

Plasma room temperature: 4 hours
Plasma frozen -20°C: 2 weeks
Plasma frozen -70°C: 6 months

Serum room temperature: 8 hours
Serum refrigerated 2-8°C: 48 hours
Serum frozen: 6 months

Clotted, hemolyzed, icteric (test specific), lipemic (test specific) improperly filled tubes, improper anticoagulant ratio (HCT >55% and citrate not adjusted), refrigerated specimens, or stability exceeded.

Note: Specimen suspected of thawing in transport, indicated by slant in aliquot or specimen in lid of tube, will have testing performed, and the comment “interpret results with caution as thawing suspected” added to results.

See individual tests.

Antithrombin III Activity, Protein C Activity, Protein S Activity with reflex to Free and Total Protein S Antigen, Lupus Sensitive APTT with reflex heparin neutralization, Mixing, and platelet neutralization confirmation; DRVVT with reflexive heparin neutralization, Mixing, and Confirmation; IgG and IgM Anticardiolipin antibodies, IgG and IgM Beta-2-Glycoprotein antibodies, if required by algorithm fibrinogen, Heparin Unfractionated and/or Thrombin Time with and without heparin neutralization if indicated.

Profile does NOT include Factor V (5) Leiden or Prothrombin gene mutation testing.

Lupus Anticoagulant Profile Workflow

THRMP, Hypercoagulation panel, Hypercoagulability, Thrombophilic, thrombotic, lupus anticoagulant

Thrombosis profile evaluates for inherited and acquired thrombophilia risk factors in patients with a clotting event and/or a strong family history of unprovoked blood clot. Results should be combined with clinical history and clinical risk factors to determine the need for extended anticoagulation. Thrombotic testing immediately after a thrombotic event is discouraged. Anticoagulant therapy and ongoing or recent thrombotic events interfere with interpreation of some results, especially lupus anticoagulant profile testing. If anticoagulation is detected the lupus profile will be resulted with a comment stating anticoagulation detect and indeterminant for lupus anticoagulant. See Anticoagulation Impact on Coagulation Tests for effects on other analytes.