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Wiriyaprasit R, Moonla K, Apiratmateekul N, Chittamma A, Kost GJ, Treebuphachatsakul W. Optimizing d-mannose and glyceraldehyde concentrations as glucose preservatives without clinically affecting biochemical test results. Pract Lab Med 2024; 39:e00388. [PMID: 38623088 PMCID: PMC11017339 DOI: 10.1016/j.plabm.2024.e00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/09/2024] [Indexed: 04/17/2024] Open
Abstract
Objectives: The objectives were to evaluate blood additives that combined lithium heparin (LH)-salt with glyceraldehyde (GLY) or d-mannose (MAN) for preserving glucose levels in plasma samples and to simultaneously determine the compatibility of these additives with 14 other biochemical tests. Methods Blood samples from 40 subjects, equally divided into healthy and diabetic groups, were collected using five different additives. The three most effective additives, LH/GLY, LH/MAN, and LH/GLY/MAN, were selected for ensuring the best preservation of glucose levels and compatibility with 14 biochemical tests. One-way analysis of variance was used to analyze the mean paired differences of glucose level and biochemical tests. Simultaneously, the clinical criteria from Johns Hopkins Hospital were used to guide the interpretation and set acceptable thresholds for measurements that exceeded the standards. Results The combination of 160 mmol/L GLY, 8.4 mmol/L MAN, and LH, maintained glucose levels at approximately 93.4-93.7 % for healthy subjects and 91.3-92.8% for subjects with diabetes mellitus over 8 h. The mean paired differences of glucose levels in preservation were statistically insignificant. The biases in 14 biochemical tests for LH/GLY/MAN and LH/MAN remained within the acceptable clinical criteria during the 8 h. Conclusions Combining 160 mmol/L GLY, 8.4 mmol/L MAN, and LH, proved more effective in maintaining glucose levels than individual additives or the conventional sodium fluoride preservative. It did not yield clinical discrepancies in the 14 biochemical tests during 8 h at room temperature.
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Affiliation(s)
- Renu Wiriyaprasit
- Reference Material and Innovation Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Khundaw Moonla
- Reference Material and Innovation Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Napaporn Apiratmateekul
- Reference Material and Innovation Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Medical Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
| | - Anchalee Chittamma
- Department of Clinical Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gerald J. Kost
- Pathology and Laboratory Medicine, POCT•CTR, School of Medicine, University of California, Davis, CA, USA
| | - Wanvisa Treebuphachatsakul
- Reference Material and Innovation Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Medical Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand
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Dibbasey M, Umukoro S, Bojang A. Comparative and stability study of glucose concentrations measured in both sodium fluoride and serum separator tubes. Pract Lab Med 2024; 39:e00360. [PMID: 38313813 PMCID: PMC10832486 DOI: 10.1016/j.plabm.2024.e00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Sodium fluoride/potassium oxalate (NaF/KOx) tubes has been regarded as the gold-standard tubes for glucose analysis. Even though their ineffectiveness in immediately inhibiting glycolysis has been reported in several studies especially in the first 1-4h, they are still used in our clinical biochemistry laboratory for glucose measurement. However, in its absence, only serum separator tubes are employed for glucose measurement. We aim to determine whether serum separator tubes (SSTs) can replace NaF/KOx tubes for laboratory measurement of blood glucose and to assess the stability of glucose concentrations for 3 days period. Methods and findings NaF/KOx tube type was the reference method while SSTs type was the candidate method for glucose measurement. A total of 50 paired samples collected separately in NaF/KOx tubes and SSTs from healthy adult participants in the Gambia Adults Reference Intervals Study (GARIS) project were used as the project sample size. Following blood collection and separation, the glucose concentration was measured within 2 h, and at 24h, 42h and 72h time-points. Our data analysis showed no significant difference in the mean glucose concentrations between the reference tube and candidate tube types (Mean difference = 0.06 mmol/L; P = 0.38) recorded in the different timepoints. Using growth trajectory and mixed effects model, the study data further showed no significant change in the glucose concentrations (p = 0.25) for three days period. Conclusions The study confirms that SSTs can produce similar glucose results when employed in the absence of NaF/KOx tubes. Besides, the glucose concentrations were stable in both tubes for three days when the samples were separated within 2 h and refrigerated in 2-8°C.
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Affiliation(s)
- Mustapha Dibbasey
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, United Kingdom
| | - Solomon Umukoro
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, United Kingdom
| | - Abdoulie Bojang
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, United Kingdom
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Nakanga WP, Balungi P, Niwaha AJ, Shields BM, Hughes P, Andrews RC, Mc Donald TJ, Nyirenda MJ, Hattersley AT. Alternative pre-analytic sample handling techniques for glucose measurement in the absence of fluoride tubes in low resource settings. PLoS One 2022; 17:e0264432. [PMID: 35226681 PMCID: PMC8884485 DOI: 10.1371/journal.pone.0264432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Sodium fluoride (NaF) tubes are the recommended tubes for glucose measurements, but these are expensive, have limited number of uses, and are not always available in low resource settings. Alternative sample handling techniques are thus needed. We compared glucose stability in samples collected in various tubes exposed to different pre-analytical conditions in Uganda. METHODS Random (non-fasted) blood samples were drawn from nine healthy participants into NaF, Ethylenediaminetetraacetic acid (EDTA), and plain serum tubes. The samples were kept un-centrifuged or centrifuged with plasma or serum pipetted into aliquots, placed in cool box with ice or at room temperature and were stored in a permanent freezer after 0, 2, 6, 12 and 24 hours post blood draw before glucose analysis. RESULTS Rapid decline in glucose concentrations was observed when compared to baseline in serum (declined to 64%) and EDTA-plasma (declined to 77%) after 6 hours when samples were un-centrifuged at room temperature whilst NaF-plasma was stable after 24 hours in the same condition. Un-centrifuged EDTA-plasma kept on ice was stable for up to 6 hours but serum was not stable (degraded to 92%) in the same conditions. Early centrifugation prevented glucose decline even at room temperature regardless of the primary tube used with serum, EDTA-plasma and NaF-plasma after 24 hours. CONCLUSION In low resource settings we recommend use of EDTA tubes placed in cool box with ice and analysed within 6 hours as an alternative to NaF tubes. Alternatively, immediate separation of blood with manual hand centrifuges will allow any tube to be used even in remote settings with no electricity.
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Affiliation(s)
- Wisdom P. Nakanga
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Priscilla Balungi
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Anxious J. Niwaha
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Beverly M. Shields
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
| | - Peter Hughes
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Rob C. Andrews
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
| | - Tim J. Mc Donald
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Moffat J. Nyirenda
- Medical Research Council/ Uganda Virus and Research Institute and LSHTM Uganda Research Unit, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Andrew T. Hattersley
- National Institute for Health Research (NIHR), Exeter Clinical Research Facility, University of Exeter, Exeter, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rendle DI, Armstrong SK, Heller J, Hughes KJ. Precision and accuracy of a point-of-care glucometer in horses and the effects of sample type. Vet J 2019; 252:105359. [PMID: 31554585 DOI: 10.1016/j.tvjl.2019.105359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/21/2022]
Abstract
Point-of-care glucometry is used commonly in clinical and research settings; however, accuracy and precision of this method are concerns. The objectives of this study were to determine the accuracy of glucometry in adult horses and the precision of duplicate measurements. Blood samples were collected from 62 horses into one plain syringe, one EDTA tube and three fluoride oxalate (FO) tubes. Immediately after collection, glucose concentrations in whole blood were determined, in duplicate, by glucometry from the syringe (plain whole blood [WB] group), EDTA tube (EDTA group) and one FO tube (FO group). One FO sample was used to measure plasma glucose concentration by a laboratory chemistry analyser (LAB group) ≤1 h after collection. The third FO tube was used to measure plasma glucose concentration by glucometry after 3 h storage (FO3hr group). Adequate precision was present for all groups (coefficient of variation: 0.7-3.5%) except WB (5.5-9.4%). Between groups, correlations were significant (P < 0.05; except for WB-EDTA), varied with group comparison, and tended to be lowest for comparisons involving WB. Mean bias was lowest for WB-LAB and greatest for FO-LAB and FO3hr-LAB; however, the limits of agreement were ≥4.65 mmol/L for WB-LAB and ≤2.75 mmol/L for most other comparisons. For the glucometer used, performance was influenced by sample type: WB was unsuitable, while FO or EDTA samples resulted in adequate precision and accuracy, provided under-estimation of glucose concentrations is accounted for by using method-specific reference ranges. Glucometer performance and optimal sample type(s) should be determined prior to use in horses.
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Gómez Rioja R, Martínez Espartosa D, Segovia M, Ibarz M, Llopis MA, Bauça JM, Marzana I, Barba N, Ventura M, García del Pino I, Puente JJ, Caballero A, Gómez C, García Álvarez A, Alsina MJ, Álvarez V. Laboratory sample stability. Is it possible to define a consensus stability function? An example of five blood magnitudes. ACTA ACUST UNITED AC 2018; 56:1806-1818. [DOI: 10.1515/cclm-2017-1189] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/16/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The stability limit of an analyte in a biological sample can be defined as the time required until a measured property acquires a bias higher than a defined specification. Many studies assessing stability and presenting recommendations of stability limits are available, but differences among them are frequent. The aim of this study was to classify and to grade a set of bibliographic studies on the stability of five common blood measurands and subsequently generate a consensus stability function.
Methods:
First, a bibliographic search was made for stability studies for five analytes in blood: alanine aminotransferase (ALT), glucose, phosphorus, potassium and prostate specific antigen (PSA). The quality of every study was evaluated using an in-house grading tool. Second, the different conditions of stability were uniformly defined and the percent deviation (PD%) over time for each analyte and condition were scattered while unifying studies with similar conditions.
Results:
From the 37 articles considered as valid, up to 130 experiments were evaluated and 629 PD% data were included (106 for ALT, 180 for glucose, 113 for phosphorus, 145 for potassium and 85 for PSA). Consensus stability equations were established for glucose, potassium, phosphorus and PSA, but not for ALT.
Conclusions:
Time is the main variable affecting stability in medical laboratory samples. Bibliographic studies differ in recommedations of stability limits mainly because of different specifications for maximum allowable error. Definition of a consensus stability function in specific conditions can help laboratories define stability limits using their own quality specifications.
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Roccaforte V, Daves M, Platzgummer S, Lippi G. The impact of different sample matrices in delayed measurement of glucose. Clin Biochem 2016; 49:1412-1415. [DOI: 10.1016/j.clinbiochem.2016.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
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Bonetti G, Cancelli V, Coccoli G, Piccinelli G, Brugnoni D, Caimi L, Carta M. Which sample tube should be used for routine glucose determination? Prim Care Diabetes 2016; 10:227-232. [PMID: 26657574 DOI: 10.1016/j.pcd.2015.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Glucose is one of the most frequently requested analytes in clinical laboratory. Blood glucose analysis is affected from in vitro glycolysis. In order to determine the most suitable blood collection tube for this purpose we have compared different tubes: sodium fluoride, lithium heparin, sodium fluoride/citrate buffer containing tubes and serum with clot activator tube for the measurement of glucose when the tube has been kept at room temperature (RT) for up to 4h. METHODS Venous blood was collected from 49 healthy volunteers into Sarstedt S-Monovettes for glucose analysis. Reference plasma glucose was determined in a lithium heparin tube and immediately placed in an ice/water slurry. Within 10min it was centrifuged at 4°C and plasma was separated from the blood cells. Samples have been preserved at RT for 1, 2 and 4h after drawing. Glucose has been determined using a hexokinase method. RESULTS Glucose levels tested in a serum with clot activator tube, in lithium heparin and in sodium fluoride/sodium EDTA tubes when compared with lithium-heparin reference plasma did not meet the desirable bias for glucose (±1.8%) when kept at RT for up to 4h. GlucoEXACT tubes, when corrected by the Sarsted recommended factor of 1.16, showed a mean (95% CI) bias of +0.96% (0.45-1.47) at 1h, +1.40% (0.88-1.93) at 2h and +0.95% (0.44-1.46) at 4h, reaching the analytical goal for the desirable bias. CONCLUSIONS Samples collected into GlucoEXACT tubes containing sodium fluoride/citrate buffer liquid mixture are equivalent to those collected in reference plasma tubes avoiding glycolysis completely and within a 4h delay in plasma separation.
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Affiliation(s)
| | - Vanessa Cancelli
- Clinical Chemistry Laboratory, A.O. Spedali Civili, Brescia, Italy
| | - Giulio Coccoli
- Clinical Chemistry Laboratory, A.O. Spedali Civili, Brescia, Italy
| | | | - Duilio Brugnoni
- Clinical Chemistry Laboratory, A.O. Spedali Civili, Brescia, Italy
| | - Luigi Caimi
- Clinical Chemistry Laboratory, A.O. Spedali Civili, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Mariarosa Carta
- Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
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Al-Kharusi A, Al-Lawati N, Al-Kindi M, Mula-Abed WA. Are tubes containing sodium fluoride still needed for the measurement of blood glucose in hospital laboratory practice? Oman Med J 2015; 29:404-7. [PMID: 25584156 DOI: 10.5001/omj.2014.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 10/28/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To compare glucose values obtained using sodium flouride (NaF) tubes and serum separation tubes (SST) in a tertiary care hospital laboratory setting. METHODS This study was conducted at the Clinical Biochemistry Laboratory, Royal Hospital, Oman. During the study period (1 September-30 November 2013), 50 pairs (one NaF tube and one SST) of patient's blood specimens were randomly collected. Following separation of plasma (NaF tubes) and serum (SST), glucose concentrations were measured by hexokinase assay using the Architect c8000. Fifteen pairs of these tubes were kept in the refrigerator at 4°C and plasma/serum glucose concentrations were measured daily up to seven days after collection. RESULTS Comparing plasma (NaF) and serum (SST) results of glucose values (n=50) showed an average difference of 0.00mmol/L (range -0.60 to +0.60mmol/L). Bland Altman analysis gave a non-significant constant bias of 0.10 ±0.195mmol/L (bias ±SD). Pearson correlation between plasma (NaF) and serum (SST) glucose concentrations revealed a significant correlation approaching unity with r(2)= 0.9991. No significant differences in glucose values were noted for both plasma and serum in 15 pairs of NaF and SST tubes when analyzed seven days following refrigeration. Hemolysis was observed in five (10%) NaF tubes compared with two (4%) SST. CONCLUSION There is no difference in glucose values collected from plasma NaF tubes or serum SST, and so SST can be used in hospital laboratory settings as there are practical advantages, including cost-effectiveness and reduction in blood volume drawn when utilizing these tubes for glucose and other tests from a single blood collection tube.
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Affiliation(s)
| | - Nuha Al-Lawati
- Department of Chemical Pathology, Royal Hospital, Muscat, Oman
| | - Manal Al-Kindi
- Department of Chemical Pathology, Royal Hospital, Muscat, Oman
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Abstract
Objectives Glucose is one of the most frequently measured analytes in laboratories. Most recent studies on glucose stabilities confirm that the sodium fluoride/potassium oxalate (NaF/KOx) tube is far from the gold standard. Citrate tubes have been suggested as the preferred tube type by many institutions. Greiner has introduced a glucose-specific tube (Glucomedics) containing NaF/KOx, citrate, and EDTA to minimise glycolysis. The aim was to determine which tube would be the most suitable for accurate glucose estimation in a routine laboratory setting. Design and methods The study process involved three experiments: (a) participant comparison using lithium heparin plasma as the comparative sample; (b) stability study (0, 1, 2 and 4 h); and (c) minimal fill volume for the citrate and the Glucomedics tubes. Results The patient comparison study of lithium heparin plasma showed that EDTA, NaF/KOx, and both citrate and Glucomedics if corrected for dilutional factors produced acceptable results. The stability study up to 4 h showed that the Glucomedics tube was most effective in preventing clinically significant change in glucose concentration at a room temperature. Both citrate and Glucomedics need to be filled within 0.5 mL of the recommended fill volume for acceptable results. Conclusion The Glucomedics tube is the most suitable for minimising glycolysis. Further improvements to it (use of correct dilutional factor and the addition of gel separator) would make this tube the benchmark for the most accurate estimation, best diagnosis and patient care decisions.
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Affiliation(s)
- Goce Dimeski
- Pathology Queensland, Chemical Pathology, Princess Alexandra Hospital, Australia
| | - Kong S Yow
- Pathology Queensland, Chemical Pathology, Princess Alexandra Hospital, Australia
| | - Nigel N Brown
- Pathology Queensland, Chemical Pathology, Princess Alexandra Hospital, Australia
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Fernandez L, Jee P, Klein MJ, Fischer P, Perkins SL, Brooks SP. A comparison of glucose concentration in paired specimens collected in serum separator and fluoride/potassium oxalate blood collection tubes under survey ‘field’ conditions. Clin Biochem 2013; 46:285-8. [DOI: 10.1016/j.clinbiochem.2012.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 11/16/2012] [Accepted: 11/27/2012] [Indexed: 10/27/2022]
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12
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Swaminathan A, Lunt H, Chang WSJ, Logan FJ, Frampton CMA, Florkowski CM. Impact of prandial status on the comparison of capillary glucose meter and venous plasma glucose measurements in healthy volunteers. Ann Clin Biochem 2012; 50:6-12. [PMID: 23148281 DOI: 10.1258/acb.2012.012084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a negative glucose gradient between the capillary and venous systems, produced by glucose uptake into peripheral tissues. This gradient is augmented by oral glucose ingestion in healthy volunteers; thus prandial status may impact on capillary glucose meter performance. Our primary aim was to investigate whether the (capillary-venous plasma) glucose difference changed in relation to prandial status, in healthy volunteers. METHODS Glucose was measured fasting and also one hour after an ad libitum breakfast, in 103 healthy volunteers. Duplicate capillary (finger stick) measurements were undertaken at both time points, using both the FreeStyle Lite and AccuChek Performa meters. Simultaneous venous (antecubital fossa) samples were centrifuged immediately after collection and plasma glucose was measured using the laboratory hexokinase method. Results were compared by Bland-Altman difference analysis. RESULTS The mean (95% CI) pre- and postprandial (capillary-plasma) glucose differences (mmol/L) were calculated for each meter. For the Freestyle Lite, the preprandial difference was -0.51 (-0.58 to -0.45) and postprandial difference was 0.81 (0.69-0.94). Corresponding differences for the Performa were -0.13 (-0.20 to -0.06) and 1.19 (1.07-1.31), respectively. T-test comparison of participants' paired pre- and postprandial (capillary-plasma) glucose differences confirmed a significant meal-related change in glucose estimation for both meters (P < 0.0001). Also, both meters read highest at lower glucose concentrations. CONCLUSIONS In healthy volunteers, both glucose meters showed a systematic positive bias one hour after breakfast. The significance of this finding in diabetes remains to be determined.
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Affiliation(s)
- Akhilesh Swaminathan
- Christchurch School of Medicine, University of Otago, 2 Riccarton Ave, Christchurch 8140, New Zealand
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Francescato M, Geat M, Stel G, Cauci S. Accuracy of a portable glucose meter and of a Continuous Glucose Monitoring device used at home by patients with type 1 diabetes. Clin Chim Acta 2012; 413:312-8. [DOI: 10.1016/j.cca.2011.10.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/30/2022]
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