Blood Collection Tubes

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Most blood collection tubes contain an additive that either accelerates clotting of the blood (clot activator) or prevents the blood from clotting (anticoagulant). A tube that contains a clot activator will produce a serum sample when the blood is separated by centrifugation and a tube that contains an anticoagulant will produce a plasma sample after centrifugation. Some tests require the use of serum, some require plasma, and other tests require anticoagulated whole blood (Table 1).

Table 1. The most commonly used blood collection tubes.Tube cap colorAdditiveFunction of AdditiveCommon laboratory tests

Light-blue

3.2% Sodium citratePrevents blood from clotting by binding calciumCoagulation

Red or gold (mottled or "tiger" top used with some tubes)

Serum tube with or without clot activator or gelClot activator promotes blood clotting with glass or silica particles. Gel separates serum from cells.Chemistry, serology, immunology

Green

For more information, please visit Disposable vacuum blood collection tube services.

Sodium or lithium heparin with or without gelPrevents clotting by inhibiting thrombin and thromboplastinStat and routine chemistry

Lavender or pink

Potassium EDTAPrevents clotting by binding calciumHematology and blood bank

Gray

Sodium fluoride, and sodium or potassium oxalateFluoride inhibits glycolysis, and oxalate prevents clotting by precipitating calcium. Glucose (especially when testing will be delayed), blood alcohol, lactic acid

The most commonly used blood collection tubes.

Overview and Uses of Vacuum Blood Collection Tubes

Vacuum blood collection tubes are essential tools in medical and laboratory settings for collecting blood samples efficiently and safely. These tubes are pre-evacuated, creating a vacuum that automatically draws a specific blood volume into the tube when a needle is inserted into a patient&#;s vein.

Key Components:

1. Tube: Made of glass or plastic, the tube is pre-filled with a vacuum that determines the amount of blood drawn.
2. Cap: The cap is color-coded based on the type of additive inside the tube, indicating its use (e.g., for serum, plasma, or whole blood).
3. Additives: Depending on the purpose, tubes may contain anticoagulants, clot activators, or gel separators. Common additives include:
   • EDTA (Ethylenediaminetetraacetic acid): Prevents blood from clotting and is used for complete blood count (CBC) tests.
   • Sodium Citrate: Used for coagulation studies by binding calcium in the blood.
   • Heparin: Prevents clotting and is used for plasma determinations.
   • Clot Activator: Promotes blood clotting for serum collection.
   • Gel Separator: Aids in separating serum or plasma from blood cells after centrifugation.

Advantages:

• Convenient and Safe: The vacuum system simplifies blood collection, reducing the risk of hemolysis and contamination.
• Precise Volumes: The vacuum ensures that the correct volume of blood is drawn, which is crucial for accurate test results.
• Multiple Samples: Multiple tubes can be filled during a single venipuncture, using a multi-sample needle, which reduces patient discomfort.
• Sterility: Vacuum tubes are sterile and sealed until use, maintaining the integrity of the blood sample.

Common Types of Vacuum Blood Collection Tubes:

1. Red Top: Red Top Blood Tube
   • Additive: None (glass tube) or clot activator (plastic tube).
   • Use: Serum collection for chemistry, serology, and immunology tests.
   • Notes: After blood collection, the blood will clot, and the serum can be separated by centrifugation.
2. Purple (Lavender) Top: Purple Top Blood Tube
   • Additive: EDTA (Ethylenediaminetetraacetic acid).
   • Use: Hematology tests such as Complete Blood Count (CBC), blood smears, and HbA1c.
   • Notes: EDTA preserves cell morphology, making it ideal for blood cell analysis.
3. Blue Top: Light Blue Top Tube
   • Additive: Sodium citrate.
   • Use: Coagulation studies, including Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT).
   • Notes: Sodium citrate binds calcium, preventing blood from clotting. A proper blood-to-additive ratio is crucial.
4. Green Top: Green Top Heparin Tube
   • Additive: Heparin (sodium, lithium, or ammonium).
   • Use: Plasma determinations in chemistry tests, blood gas analysis, and cytogenetic studies.
   • Notes: Heparin prevents clotting by inhibiting thrombin and other clotting factors.
5. Yellow Top: Yellow Top Blood Tube
   • Additive: ACD (Acid Citrate Dextrose) or gel separator with clot activator.
   • Use: ACD tubes are used for blood bank studies, HLA phenotyping, and DNA testing. Gel separator tubes are used for chemistry and serology tests.
   • Notes: The gel separator creates a physical barrier between the serum/plasma and blood cells after centrifugation.
6. Grey Top: Gray Top Glucose Tube
   • Additive: Potassium oxalate and sodium fluoride.
   • Use: Glucose testing, lactate determination, and blood alcohol levels.
   • Notes: Sodium fluoride preserves glucose by inhibiting glycolysis.
7. Black Top: Black Top Tube
   • Additive: Sodium citrate (in a different concentration than the blue top).
   • Use: Erythrocyte Sedimentation Rate (ESR) test.
   • Notes: The tube is specifically designed to measure the sedimentation rate of red blood cells.

Usage:

1. Preparation:
   • Ensure the correct tube is selected based on the required test.
   • Check the expiration date and integrity of the tube.
2. Blood Collection:
   • Attach the needle to the tube holder.
   • Perform venipuncture and insert the tube into the holder.
   • Allow the vacuum to draw the blood until the flow stops.
   • Remove the tube and gently invert it several times to mix the blood with the additive.
3. Post-Collection:
   • Label the tube with patient information and the date of collection.
   • Store and transport the sample according to the required conditions.

Precautions:

1. Tube Selection

   • Correct Tube Type: Choose the appropriate tube based on the required test (e.g., EDTA for hematology, sodium citrate for coagulation studies). Using the wrong tube can result in inaccurate or unusable results.
   • Additive Awareness: Be aware of the additives in the tubes and their interactions with the blood sample. For example, certain anticoagulants can interfere with specific tests.

2. Check Expiration Date

   • Expiration: Always check the expiration date of the tube before use. Expired tubes may lose vacuum, causing inadequate blood draw, or may have degraded additives, affecting test results.

3. Proper Blood Draw Technique

   • Avoid Hemolysis: Handle tubes gently to avoid hemolysis (rupture of red blood cells), which can interfere with test results. Do not shake the tubes; gently invert them to mix the blood with additives.
   • Correct Fill Volume: Ensure the tube is filled to the appropriate volume. Underfilling or overfilling can alter the blood-to-additive ratio, leading to inaccurate results.

4. Mixing of Additives

   • Gentle Inversion: After blood collection, gently invert the tube 8-10 times to mix the blood with the additive thoroughly. This is especially important for tubes with anticoagulants to prevent clotting.
   • Immediate Mixing: Mix the tube immediately after collection to ensure even distribution of the additive, reducing the risk of clotting or other issues.

5. Avoid Cross-Contamination

   • Order of Draw: Follow the recommended order of draw to prevent cross-contamination of additives between tubes. This is critical when multiple tubes are drawn during a single venipuncture.
   • Tube Caps: Keep tube caps on until ready to use and avoid touching the inside of the cap or the tube&#;s opening to maintain sterility.

6. Temperature and Storage Conditions

   • Temperature Control: Store and transport blood samples at the recommended temperature to preserve sample integrity. Some additives and blood components are temperature-sensitive.
   • Avoid Freezing: Do not freeze whole blood samples unless required by the specific test, as freezing can cause cell lysis and degrade certain analytes.

7. Handling Precautions

   • Proper Labeling: Immediately label the tube with the patient&#;s information, date, and time of collection to avoid mix-ups and ensure accurate tracking.
   • Avoid Excessive Pressure: Do not apply excessive pressure when attaching or detaching the tube from the needle holder, as this can cause hemolysis or loss of vacuum.

8. Transport Precautions

   • Upright Positioning: Transport tubes in an upright position to minimize the risk of leakage and ensure proper separation of blood components (e.g., in gel separator tubes).
   • Timely Transport: Ensure timely transport of the sample to the laboratory to prevent degradation of analytes, especially for time-sensitive tests.

9. Special Precautions for Certain Tests

   • Light Sensitivity: Protect samples for tests like bilirubin or certain vitamins from light by using light-blocking tubes or wrapping them in foil.
   • Anticoagulant Sensitivity: Be cautious with anticoagulant tubes (e.g., sodium citrate) to maintain the correct blood-to-additive ratio, as this directly impacts test results.

10. Disposal and Safety

    • Sharps Disposal: Dispose of needles and other sharps in appropriate sharps containers to prevent needlestick injuries.
    • Biohazard Precautions: Treat all blood collection tubes as potentially infectious and dispose of them according to biohazard regulations.

Adhering to these precautions when using vacuum blood collection tubes is crucial for maintaining sample integrity, ensuring patient safety, and obtaining accurate and reliable test results. Proper technique, careful handling, and awareness of specific tube requirements are key components of successful blood collection and testing.

Applications:

1. Hematology

   • Tubes Used: Lavender (Purple) Top (EDTA).
   • Applications:
     • Complete Blood Count (CBC): Measures various components of blood, including red blood cells, white blood cells, hemoglobin, and platelets.
     • Blood Smears: Used for microscopic examination of blood cells to detect abnormalities.
     • HbA1c Testing: Monitors long-term glucose control in diabetic patients.

• 2. Coagulation Studies

  • Tubes Used: Light Blue Top (Sodium Citrate).
  • Applications:
    • Prothrombin Time (PT): Assesses the blood&#;s ability to clot, often used to monitor patients on anticoagulant therapy.
    • Activated Partial Thromboplastin Time (APTT): Evaluates the intrinsic pathway of coagulation.
    • Fibrinogen Levels: Helps diagnose bleeding disorders.

• 3. Clinical Chemistry

  • Tubes Used: Red Top (Serum), Green Top (Heparin), Yellow Top (Gel Separator), Grey Top (Sodium Fluoride/Potassium Oxalate).
  • Applications:
    • Electrolyte Testing: Measures levels of sodium, potassium, chloride, and bicarbonate in the blood.
    • Liver Function Tests (LFTs): Assesses liver health by measuring enzymes like ALT, AST, and bilirubin.
    • Kidney Function Tests: Measures creatinine and blood urea nitrogen (BUN) to evaluate kidney performance.
    • Glucose Testing: Monitors blood sugar levels for diagnosing and managing diabetes.
    • Lipid Profile: Evaluates cholesterol and triglyceride levels to assess cardiovascular risk.
    • Hormone Testing: Measures hormones like thyroid-stimulating hormone (TSH), cortisol, and reproductive hormones.

• 4. Serology and Immunology

  • Tubes Used: Red Top (Serum), Yellow Top (Gel Separator with Clot Activator).
  • Applications:
    • Antibody Testing: Detects antibodies in the blood, such as in HIV, hepatitis, or autoimmune diseases.
    • Antigen Testing: Identifies specific antigens, such as those for infectious diseases.
    • Serum Protein Electrophoresis: Separates proteins in the blood to diagnose conditions like multiple myeloma.

• 5. Blood Banking

  • Tubes Used: Yellow Top (ACD).
  • Applications:
    • Blood Typing: Determines the blood type (A, B, AB, O) and Rh factor of a patient.
    • Crossmatching: Ensures compatibility between donor blood and recipient.
    • Antibody Screening: Detects unexpected antibodies that may cause transfusion reactions.

• 6. Molecular Diagnostics

  • Tubes Used: Lavender Top (EDTA), Yellow Top (ACD), Blue Top (Sodium Citrate).
  • Applications:
    • DNA/RNA Extraction: Collects blood for genetic testing, such as PCR or sequencing.
    • HLA Typing: Used in transplantation compatibility testing.
    • Viral Load Testing: Measures the amount of virus in the blood for diseases like HIV or hepatitis.

• 7. Toxicology and Trace Element Testing

  • Tubes Used: Blue Top (Trace Element-Free), Grey Top (Sodium Fluoride/Potassium Oxalate).
  • Applications:
    • Heavy Metal Testing: Measures levels of metals like lead, mercury, or arsenic in the blood.
    • Drug Testing: Detects the presence of drugs or their metabolites.
    • Alcohol Levels: Measures blood alcohol concentration, often used in legal and forensic settings.

• 8. Microbiology

  • Tubes Used: Yellow Top (SPS), Blood Culture Bottles.
  • Applications:
    • Blood Cultures: Detects bacterial or fungal infections in the bloodstream.
    • Mycobacterial Cultures: Used for detecting tuberculosis and other mycobacterial infections.

• 9. Erythrocyte Sedimentation Rate (ESR)

  • Tubes Used: Black Top (Sodium Citrate).
  • Applications:
    • Inflammation Detection: The ESR test measures how quickly red blood cells settle at the bottom of a tube, which can indicate inflammation or infection in the body.

Vacuum blood collection tubes are integral to a wide range of diagnostic and research applications, each tailored to specific needs through the use of various additives and designs. Understanding the appropriate application for each tube type is crucial for accurate and reliable results in clinical and laboratory settings.

Conclusion:

Vacuum blood collection tubes are a reliable and efficient method for collecting blood samples in clinical and research settings. Understanding the different types of tubes and their specific applications is crucial for ensuring accurate and reliable test results. Proper handling and usage are essential to maintain the integrity of the blood sample and prevent pre-analytical errors.

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