Effect of Anticoagulant on Blood Calcium

Effect of Anticoagulant on split atomic number 20Effect of Anticoagulant Can Heparin Produce Negative twist in the Determination of Total Blood atomic number 20?Soma Santra1, Manju Soni2, Ajay Soni2, Swati Kotwal1*KEY WORDSQuality control, pre-analytical, blood serum atomic number 20, kit method, o-CPCAbstractCalcium is a vital element in the body which plays an important physiologic role as it act as a second courier in many biochemical pathways. Accurate results of marrow and ionic atomic number 20 level plays a pivotal role in patient take and management. Measurement of serum calcium helps to identify many clinical disorders. galore(postnominal) preanalytical conditions affect the origination calcium estimation. The aim of this field of battle is to evaluate the establish of heparin, rehearse as an anticoagulant on integral kin calcium assay. Blood specimen from 10 healthy subjects were collected and the difference in follow calcium contraction in germ plasm and serum samples was assessed. none profound changes were observed when plasm levels were comp ared with the serum encourages with p value of 0.56. Deming throwback digest yielded the equation 1.02 (serum total calcium value) + 0.28 mg/dl. The bend value was -0.109 mg/dl (95% CI -0.248 0.030 mg/dl) for total calcium levels assayed using either subway system was acceptable. Total calcium values did non noteworthyly differ when either plasma or serum was spendd with the spearman correlation coefficients (r value) of 0.98. In conclusion, heparinized tubes can be make use ofd for the closing of total blood calcium. The use of plasma sample has an advantage in an emergency laboratory setting due to less processing time.KeywordsCalcium, Heparin, Quality control, Preanalytical, Phlebotomy, Blood collection deviceIntroductionIn recent years, there has been an change magnitude effort by international committees and working bases to develop quality standards for the pre-analytica l phase, including the decent use of anticoagulants in sample collection (1, 2). Anticoagulants are additives that inhibit the clot of blood they are used only on ensuring that the concentration of the core group to be measured is changed as little as realistic in advance the analytical process (3). The preanalytical laboratory visitationing takes two major locomote Blood collection and processing (4). The ionic calcium level in blood is recognized to be falsely decreased either due to dilution or binding effectuate of heparin, which is applied as an anticoagulant (5). The CSLI recommends the use of lyophilized calcium-balanced heparin syringes (6, 7) for collecting specimens for ionized calcium measurement. It has been proposed that ionized calcium levels can be affected by excess of heparin vex in blood (8), although it was believed that the clinical significance was minimal (9). In this study, we are determining the effect of heparin on assay of total blood calcium to a nalyze preanalytical defect in the collection of blood samples.Materials and MethodsThis study was approved by Swami Vivakanand Medical Mission ethical Committee. Informed accept was obtained from the donors. For evaluation of the effect of heparin on total blood calcium assay, blood samples were obtained from the 10 subjects. Blood samples were sequenti entirelyy obtained by single venipunture from an antecubital vein in BD PresetR lithium heparin tubes (Ref. No. 367884) and BD vacutainer serum (Ref. No. 367812). All the subjects were betwixt 18 50 years age group including some(prenominal) genders. Plasma levels of total calcium were compared to the serum calcium, which was used as a reference here. After the blood withdrawal, samples were then recapped into individual containers, followed by sample centrifugation. The plasma and serum samples were separated within 30 proceeding of blood collection. Commercially available biochemical kit ( crystalline Gold, Span diagnostic, I ndia) by Arenazo-III method was used for total calcium Assay. Within 2 hours later on collection, total calcium was measured in all samples in reproduce and mean was used for further analysis. Data were evaluated using Analyse-it software (version 2.26). For all statistical comparisons, p values less than 0.05 were considered significant. Data concordance was evaluated via Deming regression analysis. The mean of differences (bias) and limits of commensurateness was calculated using the Bland and Altman method (10). Differences between total calcium level obtained from plasma and serum were compared using the diametrical t-test. Correlations were determined via calculation of Spearman correlation coefficients (r values).ResultsThe total calcium values of samples canvas in the present study ranged from 8.69 10.47 mg/dl and the mean total calcium values obtained using BD lithium Heparin was 9.34 0.18 mg/dl whereas that for serum samples was 9.48 0.18 mg/dl with SD of 0.57 (Tabl e 1) by 1-way ANOVA. The Spearman correlation coefficient was r = 0.98 (p discourseSerum is the favourite(a) sample which is used by many laboratories for biochemical testing since it avoids the gain of anticoagulants that may interfere with some analytical methods or alter the true concentration of the parameters being measured. The use of serum or plasma in clinical pathology remains controversial. However, analyte stability is greater in serumthan in plasma (11, 12) and differences between plasma and serum test results have often been documented (13). Moreover, in stored samples, the formation of fibrin strands is lower in serum than in plasma and therefore, there is lesser risk of cloture in automated biochemical analyzers. However the use of plasma is preferred in some centres as it separates quickly saving preanalytical time gum olibanum reducing the total testing period (TTP) secondly, 1520% much plasma sample can be obtained from the same volume of blood than the serum sample and lastly, with plasma there are no coagulation-induced changes or interferences (3). Heparin has been generally recommended as the most suitable anticoagulant for plasma collection (14) due to its physiological acceptance in vivo. Although in preceding(prenominal) reports, a significant differences in selected parameters have been found between heparinized plasma and serum samples (13, 15).In our study, serum and heparinized plasma yielded similar results with no significant changes in total blood calcium assay this confirms the views of Thorensen, S.I.,et al (15) who excessively reported similar observations and this adds up to the observation of Ladenson, J., et al (13) in which clinically significant changes were observed in ionic calcium observations on use of heparinized plasma over serum results.. We found that the Spearman correlation coefficient was 0.98, indicating a dear correlation, when total calcium test results when plasma and serum were compared. Deming r egression analysis yielded the slope of the regression line that did not approximate unity, suggesting that, in addition to the presence of a small constant bias, a small and non-significant proportionate difference also existed between the test results obtained upon use of the two tube types (16). The total calcium assay bias was -0.109 mg/dl. The criteria of acceptable limits imprecision for total calcium assay is 1mg/dl and medically allowable error is 0.37 mg/dl (17, 18). In the present study, we observed that the total calcium concentrations of plasma samples were slightly lower than serum samples with no clinically significant differnece and the bias values were smaller than US CLIA 1988 targets.Although collection of blood samples from the patients administered with heparin prior to the collection may hold in excess of heparin, change magnitude clotting time in the collection tube and thereby change magnitude the potential for the establishment of latent fibrin in the pre analytical phase. Preanalytical variables associated with blood collection should be further standardized to ensure the accuracy of test results. It is impractical to call tube manufacturers to test out their subway systems on all possible assay platforms this is a project for individual research laboratories.ConclusionWe leave off that heparinized tubes are suitable for sample collection for total calcium assay. 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