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Lima-Oliveira G, Brennan-Bourdon LM, Varela B, Arredondo ME, Aranda E, Flores S, Ochoa P. Clot activators and anticoagulant additives for blood collection. A critical review on behalf of COLABIOCLI WG-PRE-LATAM. Crit Rev Clin Lab Sci 2020; 58:207-224. [PMID: 33929278 DOI: 10.1080/10408363.2020.1849008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In the clinical laboratory, knowledge of and the correct use of clot activators and anticoagulant additives are critical to preserve and maintain samples in optimal conditions prior to analysis. In 2017, the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) commissioned the Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) to study preanalytical variability and establish guidelines for preanalytical procedures to be applied by clinical laboratories and health care professionals. The aim of this critical review, on behalf of COLABIOCLI WG-PRE-LATAM, is to provide information to understand the mechanisms of the interactions and reactions that occur between blood and clot activators and anticoagulant additives inside evacuated tubes used for laboratory testing. Clot activators - glass, silica, kaolin, bentonite, and diatomaceous earth - work by surface dependent mechanism whereas extrinsic biomolecules - thrombin, snake venoms, ellagic acid, and thromboplastin - start in vitro coagulation when added to blood. Few manufacturers of evacuated tubes state the type and concentration of clot activators used in their products. With respect to anticoagulant additives, sodium citrate and oxalate complex free calcium and ethylenediaminetetraacetic acid chelates calcium. Heparin potentiates antithrombin and hirudin binds to active thrombin, inactivating the thrombin irreversibly. Blood collection tubes have improved continually over the years, from the glass tubes containing clot activators or anticoagulant additives that were prepared by laboratory personnel to the current standardized evacuated systems that permit more precise blood/additive ratios. Each clot activator and anticoagulant additive demonstrates specific functionality, and both manufacturers of tubes and laboratory professional strive to provide suitable interference-free sample matrices for laboratory testing. Both manufacturers of in vitro diagnostic devices and laboratory professionals need to understand all aspects of venous blood sampling so that they do not underestimate the impact of tube additives on laboratory testing.
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Affiliation(s)
- G Lima-Oliveira
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - L M Brennan-Bourdon
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Comisión Para la Protección Contra Riesgos Sanitarios del Estado de Jalisco (COPRISJAL), Secretaria de Salud, Guadalajara, México
| | - B Varela
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Quality Assurance, LAC, Montevideo, Uruguay
| | - M E Arredondo
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Management Area, Clinical Laboratory, BIONET S.A, Santiago, Chile
| | - E Aranda
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Laboratory of Thrombosis and Hemostasis, Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S Flores
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Clinical Laboratory, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - P Ochoa
- Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM), Latin America Confederation of Clinical Biochemistry (COLABIOCLI), Montevideo, Uruguay.,Facultad de Medicina, Universidad Católica de Cuenca, Cuenca, Ecuador
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Zhao KN, Dimeski G, de Jersey J, Johnson LA, Grant M, Masci PP, Lavin MF. Next-generation rapid serum tube technology using prothrombin activator coagulant: fast, high-quality serum from normal samples. ACTA ACUST UNITED AC 2018; 57:483-497. [DOI: 10.1515/cclm-2018-0397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/31/2018] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Incomplete blood clotting or latent clotting in serum is a common laboratory problem, especially for patients on anticoagulant therapy or when serum tubes are centrifuged before clotting is completed. We describe a novel approach to producing high-quality serum using snake venom prothrombin activator complex (OsPA) as an additive in blood collection tubes for non-anticoagulated (normal) individuals.
Methods
Plasma clotting assays were performed using a Hyland-Clotek instrument. Blood clotting was visually observed, and thromboelastography was also performed to determine the important parameters of coagulation. Thrombin generation was assayed using the chromogenic substrate S-2238, and biochemical analytes in the serum were determined on chemistry and immunoassay analysers. Fibrinogen was determined by either ELISA or Clauss fibrinogen assay.
Results
We initially showed that OsPA had strong coagulation activity in clotting not only recalcified citrated plasma and recalcified citrated whole blood, but also fresh whole blood in a clinical setting. The use of TEG clearly showed improved speed of clotting and generation of a firmer clot. We also showed that the use of OsPA to produce serum did not interfere with the determination of commonly measured biochemical analytes. The underlying clotting mechanism involves a burst of thrombin production at the initial stages of the clotting process upon contact with prothrombin in blood.
Conclusions
These results demonstrate rapid generation of high-quality serum, contributing to faster turnaround times with standardised quality samples, for accurate analyte determinations in normal individuals.
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Affiliation(s)
- Kong-Nan Zhao
- Centre for Venomics Research, School of Medicine , The University of Queensland, Translational Research Institute , Woolloongabba, QLD , Australia
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women’s Hospital Campus , Herston, Brisbane, QLD , Australia
| | - Goce Dimeski
- Chemical Pathology, Princess Alexandra Hospital , Woolloongabba, Brisbane, QLD , Australia
- School of Chemistry and Molecular Biosciences , The University of Queensland, Brisbane , QLD , Australia
| | - John de Jersey
- School of Chemistry and Molecular Biosciences , The University of Queensland, Brisbane , QLD , Australia
| | - Lambro A. Johnson
- Centre for Venomics Research, School of Medicine , The University of Queensland, Translational Research Institute , Woolloongabba, QLD , Australia
| | | | - Paul P. Masci
- Centre for Venomics Research, School of Medicine , The University of Queensland, Translational Research Institute , Woolloongabba, QLD , Australia
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women’s Hospital Campus , Herston, Brisbane, QLD , Australia
| | - Martin F. Lavin
- Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women’s Hospital Campus , Herston, Brisbane, QLD 4029 , Australia , Phone: +61 07 3346 6045, Fax: +61 07 3346 5509
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Moore GW, Brown KL, Bromidge ES, Drew AJ, Ledford-Kraemer MR. Lupus anticoagulant detection: out of control? Int J Lab Hematol 2012; 35:128-36. [DOI: 10.1111/ijlh.12006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 08/08/2012] [Indexed: 01/05/2023]
Affiliation(s)
- G. W. Moore
- Department of Haemostasis and Thrombosis; GSTS Pathology; Guy's & St. Thomas' Hospitals; London; UK
| | - K. L. Brown
- Department of Haemostasis and Thrombosis; GSTS Pathology; Guy's & St. Thomas' Hospitals; London; UK
| | - E. S. Bromidge
- Department of Haemostasis and Thrombosis; GSTS Pathology; Guy's & St. Thomas' Hospitals; London; UK
| | - A. J. Drew
- Department of Haemostasis and Thrombosis; GSTS Pathology; Guy's & St. Thomas' Hospitals; London; UK
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Moore GW, Henley A, Greenwood CK, Rangarajan S. Further evidence of false negative screening for lupus anticoagulants. Thromb Res 2008; 121:477-84. [PMID: 17602725 DOI: 10.1016/j.thromres.2007.05.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 04/16/2007] [Accepted: 05/22/2007] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Accurate and timely detection of lupus anticoagulants (LA) is of diagnostic and prognostic importance due to the association of persistent LA with thrombotic disease. Antibody heterogeneity and assay variability complicate LA detection and weak antibodies can go undetected. METHODS Screen and confirm assays on equal volume mixing studies were performed on known LA using dilute Russell's viper venom time (DRVVT), dilute activated partial thromboplastin time (DAPTT) and activated seven lupus anticoagulant (ASLA) assay. Two established calculations for phospholipid dependence were applied to ascertain whether any antibodies diluted to within screening test reference ranges maintained a significant difference between screen and confirm results sufficient to imply LA activity. We then performed confirmatory tests on neat plasma samples from patients with thrombotic disease whose screening tests were within reference ranges. RESULTS Forty nine of 155 DRVVT positive LA were conventionally positive in the mixing studies and 8 of the 106 negative mixing studies showed significant screen and confirm test discordance. This was the case for 21 of 56 negative DAPTT mixing studies and 2 of 39 negative ASLA mixing studies. Performance of confirm assays on the neat plasma samples with screen results within reference ranges revealed possible LA activity in 19 of 166 DRVVT results, 63 of 184 DAPTT results and 9 of 117 ASLA results. CONCLUSIONS LA activity can be demonstrated by assessment of screen and confirm data irrespective of screening test elevation above a reference range. Other workers have demonstrated this phenomenon in APTT using different study designs and it may be that standard interpretation criteria warrant re-assessment.
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Affiliation(s)
- G W Moore
- Centre for Haemostasis and Thrombosis, Haemophilia Reference Centre, 1st Floor North Wing, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, England.
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