JHSM

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
The transition from gel separatory serum tubes to lithium heparin gel tubes in the clinical laboratory
Aims: To assess the viability of replacing serum samples with plasma samples in various clinical chemistry and immunoassay tests and to examine the implications of turnaround time (TAT) and sample quality during the transition process.
Methods: We compared the results of 27 paired clinical chemistry and 13 immunoassay tests from samples obtained using gel separator serum and gel separator lithium heparinized plasma (LIH) tubes. We used regression analysis, bias values, and Bland-Altman plots to compare the performance of serum and LIH tubes in various clinical chemistry and immunoassay tests. We collected and evaluated sample aspiration errors, hemolysis index values, and TAT data from the laboratory information system before and after switching to plasma in our study.
Results: Most tests showed no significant difference between the serum and LIH. However, for some analytes, total error (TE) values exceeded the total allowable error (TEa) limits derived from the biological variation database. Notably, insulin TE value did not exceed TEa, but it consumed near all its error budget. Consequently, we determined the alternative allowable error limits for some tests and found that plasma tubes could be used instead of serum tubes for most tests, except for lactate dehydrogenase (LDH). Plasma tubes improved the sample quality, reduced the incidence of aspiration errors, and decreased TAT in the emergency laboratory. We observed significant reductions in TAT after switching to plasma tubes.
Conclusion: Our study showed that LIH tubes can replace serum tubes in most clinical chemistry and immunoassay tests. Using LIH tubes in clinical laboratories can improve healthcare quality and reduce the workload of the laboratory staff.


1. World Health Organization. Diagnostic Imaging and LaboratoryTechnology. (2002). Use of anticoagulants in diagnostic laboratoryinvestigations. World Health Organization. Accessed May 3, 2023.https://apps.who.int/iris/handle/10665/65957
2. Valenstein P. Laboratory turnaround time. Am J Clin Pathol.1996;105(6):676-688. doi:10.1093/ajcp/105.6.676
3. Güvenç Demirağcı Y. Laboratuvar sonuç verme sürelerinindeğerlendirilmesi. ET J. 2018;5(3):54-58.
4. Arslan FD, Karakoyun I, Basok BI, et al. The local clinical validationof a new lithium heparin tube with a barrier: BD Vacutainer®Barricor LH plasma tube. Biochem Medica. 2017;27(3):030706.doi:10.11613/BM.2017.030706
5. Lippi G, Cornes MP, Grankvist K, Nybo M, Simundic AM. EFLMWG-Preanalytical phase opinion paper: local validation of bloodcollection tubes in clinical laboratories. Clin Chem Lab MedCCLM. 2016;54(5). doi:10.1515/cclm-2015-1274
6. CLSI. Validation and Verification of Tubes for Venous andCapillary Blood Specimen Collection; Approved Guideline. CLSIdocument GP34-A Wayne, PA: Clinical and Laboratory StandardsInstitute; 2010.
7. Quality Requirements-Westgard. Accessed February 5, 2023.https://www.westgard.com/quality-requirements.htm
8. Aarsand AK, Fernandez-Calle P, Webster C, et al. The EFLMBiological variation database. Accessed Jue 25, 2023. Available at:https://biologicalvariation.eu/
9. Sun H, Wang W, Zhao H, et al. Internal quality control status forBNP and NT-proBNP in China from 2014 to 2017. J Clin LabAnal. 2019;33(1):e22643. doi:10.1002/jcla.22643
10. Oosterhuis WP, Coskun A, Sandberg S, Theodorsson E.Performance specifications for sodium should not be basedon biological variation. Clin Chim Acta. 2023;540:117221.doi:10.1016/j.cca.2023.117221
11. Hétu PO, Hobeila S, Larivière F, Bélanger MC. Improved samplequality and decreased turnaround time when using plasma bloodcollection tubes with a mechanical separator in a large universityhospital. J Appl Lab Med. 2021;6(2):409-420. doi:10.1093/jalm/jfaa111
12. Lima-Oliveira G, Monneret D, Guerber F, Guidi GC. Samplemanagement for clinical biochemistry assays: Are serum andplasma interchangeable specimens? Crit Rev Clin Lab Sci.2018;55(7):480-500. doi:10.1080/10408363.2018.1499708
13. Wang YS, Feng CF, Er TK, et al. Comparison of cardiac troponinI levels in serum and sodium-citrate plasma using the ACCESS 2immunoassay. Ann Clin Lab Sci. 2005;35(4):453-454.
14. Ercan Ş. Comparison of test results obtained from lithium heparingel tubes and serum gel tubes. Turk J Biochem. 2020;45(5):575-586. doi:10.1515/tjb-2019-0117
15. Ferrari D, Strollo M, Vidali M, Motta A, Pontillo M, Locatelli M.Biochemical, immunochemical and serology analytes validationof the lithium heparin BD Barricor blood collection tube ona highly automated Roche COBAS8000 instrument. Acta BioMedica Atenei Parm. 2020;91(1):47-55. doi:10.23750/abm.v91i1.9195
16. Arslan FD, Karakoyun I, Basok BI, et al. The local clinical validationof a new lithium heparin tube with a barrier: BD Vacutainer®Barricor LH Plasma tube. Biochem Medica. 2017;27(3):030706.doi:10.11613/BM.2017.030706
17. Bockoven C, Granato M, Benirschke R, Lee H. Differing plasmaand serum lactate dehydrogenase concentrations. Am J ClinPathol. 2018;149(suppl_1):S13-S13. doi:10.1093/ajcp/aqx116.029
18. Vestgard J. Consolidated Comparison of Chemistry PerformanceSpecifications-Westgard. Accessed April 4, 2023. https://www.westgard.com/consolidated-goals-chemistry.htm
19. Kalra A. Decoding the bland-altman plot: basic review. J PractCardiovasc Sci. 2017;3(1):36. doi:10.4103/jpcs.jpcs_11_17
20. Orhan B, Mercan H, Deniz L, Erdogan Z, Bercik Inal B.Comparison of Barricor tube and serum separator tube inoutpatients. Turk J Biochem. 2022;47(6):719-726. doi:10.1515/tjb-2022-0168
21. Cadamuro J, Mrazek C, Leichtle AB, et al. Influence ofcentrifugation conditions on the results of 77 routine clinicalchemistry analytes using standard vacuum blood collectiontubes and the new BD-Barricor tubes. Biochem Medica.2018;28(1):010704. doi:10.11613/BM.2018.010704
22. Shin S, Oh J, Park HD. Comparison of three blood collectiontubes for 35 biochemical analytes: the Becton Dickinson Barricortube, serum separating tube, and plasma separating tube. Ann LabMed. 2021;41(1):114-119. doi:10.3343/alm.2021.41.1.114
23. Kösem A, Topçuoğlu C, Sezer S, et al. Comparison of somebiochemical tests in different blood collection tubes inhemodialysis patients. Turk J Biochem. 2020;45(1):26-36.doi:10.1515/tjb-2018-0341
24. Gawria G, Tillmar L, Landberg E. A comparison of stability ofchemical analytes in plasma from the BD Vacutainer ® BarricorTMtube with mechanical separator versus tubes containing gelseparator. J Clin Lab Anal. 2020;34(2). doi:10.1002/jcla.23060
25. Dimeski G, Johnston J. Is the BD Barricor tube the new standardfor lithium heparin plasma. Developments Clin Med Pathol.2018;1(3):1-5 doi: 10.31031/DCMP.2018.01.000514
26. Ryan J, Stuart L, Southby S, et al. Comparison of BD Vacutainer®rapid serum tube and plasma for haemolysis markers in theemergency department. Ann Clin Biochem Int J Lab Med.2015;52(2):293-296. doi:10.1177/0004563214533317
27. Miles RR. Comparison of serum and heparinized plasmasamples for measurement of chemistry analytes. Clin Chem.2004;50(9):1703-1704. doi:10.1373/clinchem.2004.036483
28. Ramakers C, Meyer B, Yang W, et al. Switching from serum toplasma: Implementation of BD Vacutainer® BarricorTM plasmablood collection tubes improves sample quality and laboratoryturnaround time. Pract Lab Med. 2020;18:e00149. doi:10.1016/j.plabm.2019.e00149
29. Badiou S, Vuillot O, Bargnoux AS, et al. Improved quality ofsamples and laboratory turnaround time using 3.5 mL low vacuumBD Vacutainer® Barricor tubes in the emergency department.Pract Lab Med. 2019;16:e00128. doi:10.1016/j.plabm.2019.e00128
Volume 6, Issue 5, 2023
Page : 998-1009
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