Specimen Collection Manual and Test Catalog

GMC, GWV, GCMC, GLH, GJSH and GMCM: One (1) EDTA lavender-top tube and one (1) sodium citrate blue-top tubes. 

GSACH, GBH, GSWB: One (1) EDTA lavender-top tube and two (2) sodium citrate blue-top tubes. Prepare two (2) 1 mL aliquots of plasma for Fibrinogen.

Test may only be collected and performed on inpatients at testing laboratory locations (see below). 

• Ideally the patient should not be receiving anticoagulant medication as it may interfere with testing and cause erroneous results. See Anticoagulation Impact on Coagulation Tests.
• 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.

Centrifuge the citrated blue-top tubes at designated time and speed to obtain platelet free plasma. 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. Two aliquots needed. Check the residual specimen for clot and if present discard sample and redraw specimen. Freeze upright and transport on dry ice. 
Submit EDTA specimen for platelet testing.

Plasma aliquots: Frozen 
EDTA whole blood: Refrigerated

Plasma Room temperature: 4 hours
Plasma Frozen -20°C: 2 weeks 
Plasma Frozen -70°C: 6 months 
EDTA Room temperature: 24 hours 
EDTA Refrigerated: 72 hours

Plasma: Clotted, hemolyzed, 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. 

EDTA: Clotted, frozen, underfilled, overfilled, hemolyzed, or centrifuged specimens. Specimens beyond stability limits.

See Individual test procedure

PTINR, APTT, Fibrinogen, D-Dimer, and Platelet Count

DIC Profile

DIC can manifest as bleeding, clotting, or concurrent bleeding and clotting. It is often a result of severe organ dysfunction. The diagnosis is clinical and laboratory tests are available to support the diagnosis if necessary. The DIC panel includes those tests that are readily available (PT, APTT, D-dimer, and Platelet count) to evaluate for DIC. Please see the individual tests for their clinical significance.