If the patient’s known hematocrit value is above 55%, an adjustment of the ratio of anticoagulant to blood is necessary. sample arrival in laboratory. All syringes, catheters, pots or other tube samples will be refused. Insufficient quantity of the anticoagulants. Nevertheless, incorrect or inappropriate test results will on occasion be reported to clinicians, most often due to circumstances beyond the control of the laboratories performing these tests. Obtain a platelet count on the plasma to verify the count. MiniCollect® Coagulation tubes are plastic, non-evacuated, sterile low sample … Activated Partial Thromboplastin time (APTT) 1x Sodium Citrate tube. Call the laboratory for a special collection tube for that hematocrit value. Attach a needle to the syringe. 2,3 The sample should be mixed immediately by gentle inversion at least six times to ensure adequate mixing of the anticoagulant with the blood. FX (Grey) 4 ml Glucose, Lactate, Blood Alcohol Mix sample by gentle inversion 8-10 times. Modern instrumentation is generally capable of providing highly accurate test results. Artefactual prolongation of the APTT may be due to: the presence of heparin in the sample; difficult or slow collection; addition of an incorrect volume of blood to the tube; delay in mixing blood with the citrate anticoagulant; or; suboptimal specimen storage or a prolonged interval between collection and testing. The line should be Container(s): Lt Blue/Citrate Required Vol: one 1.8 mL tube or one 2.7 mL tube (do NOT over or under fill). SPECIMEN COLLECTION. 3. 2. Coagulation Screen (INR, APTT, Fibrinogen) Test Code COAGS1-CS Specimen Type. They are available with a citrate concentration of 0.109 mol/l (3.2%) or 0.129 mol/l (3.8%). APTT from the HFHS Medical Centers: If patient is not receiving heparin, specimen may be sent in the native tube at room temperature or in a common cooler for up to 12 hours after collection. Component Test Code*. an integrated collection scoop. Improper ratio of blood to anticoagulant. (It may be necessary to double spin too achieve this). Coagulation samples are especially vulnerable to preanalytic variables • Sample collection initiates clotting • Complex nature of enzymatic (APTT and PT) reactions measured • In vitro. We found no statistically significant difference in PT results from a 3.2% citrate tube between fill volumes of 60% and 100% and none for APTT results between fill volumes of 70% and 100%. APTT test can be used to monitor patients receiving Unfractionated Heparin therapy. 2. ORDERING INFORMATION: Geisinger Epic Procedure Code: LAB1773 Geisinger Epic ID: 31808. Sample collection initiates clotting PT and PTT are complex enzymatic reactions 1. Container/Tube: Light-blue top (3.2% sodium citrate) tube, properly filled. Minimum Volume 1.4 mL tube - filled to the line. Aliquot plasma into plastic vial leaving 0.25 mL in the bottom of centrifuged vial. Specimen submitted must be platelet-free (platelet count <8,000/mm3). Minimum Vol: N Note: This is enough for a PT, PTT, TT, and Fibrinogen to be run on the same sample.Preferred method of collection is venipuncture with vacuum fill. Recollect specimen ensuring proper fill to achieve a blood to anticoagulant ratio of 9:1. 14979-9. into a polypropylene tube. Plebani M: Quality indicators to detect pre-analytical errors in Laboratory testing. Patient’s with a hematocrit level >55% must have a special tube made to adjust for the hematocrit; contact lab for a special tube. Blood Collection: • Serum: Draw a sufficient amount of whole blood into a plain, red top tube or a serum gel tube. There is currently a nationwide shortage of this tube, anticipated to last through August 2021. Drawing a discard tube will displace the air from the blood collection set tubing to ensure proper blood draw volume. APTT should be tested within 4 hours of collection. Improper transport of the sample. Specimens collected from patients receiving heparin therapy must be centrifuged within 1 hour and the plasma removed and frozen, if not test should be run immediately. Specimen Requirements. Mix sample by gentle inversion 8 -10 times PPT (Pearl) 5 ml Homocysteine, ACTH Mix sample by gentle inversion 8-10 times. Capillary collection is unacceptable. The MiniCollect® 9NC Coagulation blood collection tube is also featured with a colour coded co-molded cap which can easily be removed during the collection and sampling process. This aPTT test is for screening purposes only and is not intended for therapeutic monitoring. Fill tube to stated capacity. Citrate Must be venous or arterial collection, NOT capillary. Obtain special tube from lab if patient's hematocrit is over 55%. Sometimes a traumatic or difficult blood collection may result in activation of the coagulation pathway in the sample, resulting in a shortened aPTT time. In this case a recollection of the blood sample may be required to obtain an accurate result. Pre-analytical problems. These may include: Centrifuge for 10 minutes at 3,000 rpm. The waste tube does not need to be completely filled. Once blood flows through the tubing, the waste tube can be removed and discarded. evacuated tube system is used, the coagulation sample should be the second tube collected, unless a PT or APTT only is ordered. Specimen type: Platelet-free plasma. 0030235. Test results are affected by incorrect blood volume, note fill line on tube. SPECIMEN COLLECTION AND HANDLING Throughout the procedure for determination of activated partial thromboplastin times (aPTT) all test tubes, syringes and pipettes must be plastic or siliconized glass. Hello, Elvin Tiamzon, and thank you for your question. Tube MUST be full. Container: Blue-topped (3.2% sodium-citrate) tube. Alternate Collection … Criteria for the rejection of the blood sample: Blood samples are not labeled or not properly labeled. Collection Instructions: 1. Incorrect fill in specimen collection tube; Specimen Type: Plasma. Patient has a hematocrit level above 55%. Preferred collection container: 2.7 mL blue-top (3.2% sodium citrate) tube. Must collect up to black mark on tube. Heparin anticoagulant therapy (the target aPTT is usually 1.5 to 2.5 times longer than that of a 'normal' control sample (referred to as the 'aPTT ratio'). Carefully puncture the stopper of an evacuated test tube containing sodium citrate (3.2%) and allow blood to be drawn into the tube until the flow stops. It should contain at least 1ml of blood , but more is preferred by the labs if at all possible. Finally the plasma sample must be free from residual platelets (< 10 x109 /l) and frozen immedia-tely at -20°C or ideally at -80°C. MUST BE FILLED TO THE LINE OTHERWISE THE SAMPLE WILL BE REJECTED. APTT. APTT, HEPARIN NEUTRALIZED. Please refer to Heparin Anti-Xa [117101] and thrombin inhibitors, etc for aPTT testing. COLLECTION TUBES • It is highly recommended that blood specimens for coagulation testing be collected by venipuncture using a vacuum collection device that collects the specimen directly into an evacuated tube with a non-wettable surface. Activated Partial Thromboplastin time (aPTT) may be performed on the same collection tube as Prothrombin Time and Fibrinogen. Collect a sufficient sample to fill the blood collection tube. If on heparin therapy, whole blood specimen must be centrifuged and tested within 1 hour of collection. This waste tube is drawn first to remove the air in the tubing of the winged collection device. A wrong collection tube is used. Nowadays, there are commercially color-coded tubes available: For nonlocal specimen: Centrifuge the specimen within 30 minutes of collection in capped tube at 3500 rpms for 10 minutes. 2. Whole blood samples from patients receiving Unfractionated Heparin therapy must be received in the lab and centrifuged within one (1) hour of sample collection. APTTP : Specimen Type: Platelet-poor plasma Collection Container/Tube: Light-blue top (3.2% sodium citrate) Submission Container/Tube: Plastic vial Specimen Volume: 1 mL Collection Instructions: 1. Inadequate filling of the collection tube … Excess anticoagulant causes prolonged PT or aPTT result. Insufficient blood quantity. Blood should be collected in a blue-top tube containing 3.2% buffered sodium citrate. Coagulation tubes are mainly used for examination of coagulation parameters and can provide an excellent condition for the test of PT, APTT VALUES. Coagulation Tube with Sandwich Material consists of inner tube made of PP and outer tube made of PET. If the patient's hematocrit exceeds 55%, the volume of citrate in the collection tube must be adjusted. Prothrombin Time. Venous blood is drawn into a 3.2% buffered sodium citrate tube (blue top tube), yielding a whole blood sample with a 9:1 blood to anticoagulant ratio. Improper ratio of blood to anticoagulant. Cause of False Elevation of PT and or aPTT Test Result. Utilized with appropriate internal quality control and external quality assurance measures, analytical errors within hemostasis testing are generally minimal. Excess anticoagulant causes prolonged PT or aPTT result. The aPTT is relatively insensitive to warfarin and not used to monitor therapy, but it may be affected by it. If unable to. Mixing the samples. Collection: A clean venipuncture is essential, avoid foaming. Draw a full tube. Factors II, V and X deficiencies (normally detected by the prothrombin time) can also be detected by the aPTT. Blood collection tube is inadequately filled. If blood is drawn from an indwelling catheter, heparin or saline contamination may be a possibility. Laboratory to clarify the specimen requirements. 1 Evacuated collection tubes must be filled to completion to ensure a proper blood-to-anticoagulant ratio. Refer Coagulation Collection Procedures for directions. In particular, it has been suggested that the precision of fibrinogen measurements might be influenced by procedures used for specimen collection, leading to the suggestion that the first tube of blood collected be discarded . Coagulation Tube. However, for fresh plasma samples, the APTT, PT/INR, and Thrombin Time are not affected by platelet counts as high as 200,000 /μL. The APTT is a useful and effective method for screening patients with a bleeding tendency, for evaluating the effect of therapy in procoagulant disorders and as the basis for several specific coagulation factor assay procedures. Test performed 7 days/24 hours. This tube must be second tube drawn. Do not underfill or overfill past tube’s vacuum capacity. Specimen tube must be full. Patient has a hematocrit level above 55% This is achieved with the above blood method. The activated partial thromboplastin time (aPTT) test is a screening procedure used primarily to determine deficiencies in factors necessary for the formation of intrinsic prothrombin activator, namely factors VIII, IX, XI and XII. Overall, a significant impact on patient care arising from diagnostic errors has b… Centrifuge 15 minutes at minimum speed of 3,000 rpm’s. Coagulation tubes are mainly used for examination of coagulation parameters and can provide an excellent condition for the test of PT, APTT VALUES. 2. Blood sample showing hemolysis. Prefer 2.7 or 5 ml tubes. Partial Thromboplastin Time. For patients >1 year of age or >10kg, a 3 mL specimen tube is preferred. Avoid contaminating the sample with tissue thromboplastin or heparin. Activated Partial Thromboplastin Time (APTT) Indicate anticoagulation status on request form. If patient is on heparin therapy, samples must be in the lab within one hour after draw. Special notes: Do not draw blood from a heparinized line. 5. The waste tube must also be a light-blue top tube or a tube that contains no additives. Transport at room temperature (RT). Allow blood to clot at ambient temperature for 20 to 30 minutes. LOINC. The aPTT test measures the length of time (in seconds) that it takes for clotting to occur when reagents are added to plasma (liquid portion of the blood) in a test tube. How is the sample collected for testing? A blood sample is obtained by inserting a needle into a vein in the arm. How is it used? This effect was less pronounced when samples were drawn into 3.2% sodium citrate. Whole blood specimen should be double centrifuged and plasma separated from cells within 4 hours of collection. The CLSI recommends that the capped specimen tube must be centrifuged for sufficient time and speed (10 minutes at 1500 g The sample should be mixed with anticoagulant rapidly to prevent clotting occurring within the tube. Centrifuge, remove plasma and centrifuge plasma again. Tubes with additives are NOT to be collected before the coagulation sample. transport tube upright at RT. Following collection, blood should be adequately and promptly mixed by three to six complete end-over-end inversions of the tubes in order to ensure complete distribution of anticoagulant [8, 36, 47, 49, 57].Mixing samples is an important way to prevent in-vitro clot formation. While there are a number of definitive articles on “underfilling” 3.2% sodium citrate whole blood collection tubes, there are Fibrinogen, etc.) Sample Requirements. Discard the … Entire sample must be collected with single collection, pooling of sample is unacceptable. Routine coagulation studies (PT, aPTT) were run on both samples on the STA Compact Analyzer in accordance with manufacturer instructions. Artefactual prolongation of the APTT may be due to: the presence of heparin in the sample; difficult or slow collection; addition of an incorrect volume of blood to the tube; delay in mixing blood with the citrate anticoagulant; or suboptimal specimen storage or a prolonged interval between collection and testing. Corrective Action. Component Chart Name. Warfarin anticoagulation therapy. Long butterfly catheters are used for sample collection and slow sample draws can be problematic. Specimen Volume:3 mL. The pink tube needs inverting about 8 times to mix the sample with the EDTA. 1. Blood collection tube is inadequately filled. Results available 1 - 2 hours after. APTT is not indicated for patients receiving Low Molecular Weight Heparin.

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