Anticoagulants

EDTA – preferred anticoagulant for platelet counting

- used in preparation of blood smears [used within <2 hours]
- mode of action: chelates calcium [removes calcium]
- optimum concentration: 1.5mg/mL [mL is blood]

[Platelet satellitism – adherence of platelets to PMNs (polymorphonuclear cells); decreased number of

platelet count; recollect new specimen and use citrate as anticoagulant then multiply by 1.1 the result
from the machine to correct]

Citrate – coagulation studies (light blue tops only)

- platelet studies (light blue tops only)
- erythrocyte sedimentation rate “Westergren” (black tops only)
- mode of action: binds to calcium
- concentration: 3.2% (0.109M) / 1:9 anticoagulant to blood ratio (light blue)
3.8% (0.129M) / 1:4 anticoagulant to blood ratio (black)

Oxalate – erythrocyte sedimentation rate “Wintrobe”

- mode of action: binds to calcium to form insoluble complexes
- optimum concentration: 1-2mg/mL
- potassium oxalate = shrinks cells
- ammonium oxalate = swells cells
- double/balanced = ratio of 2:3 (potassium to ammonium ratio)
Heparin – naturally occurring anticoagulant in the body
- lithium heparin
- sodium heparin [injectable form used in anticoagulant therapy]
- osmotic fragility test
- blood gas analysis
- mode of action: inactivation of thrombin by accelerating antithrombin III
- optimum concentration = 15-20U/mL

Fluoride – glucose testing; preserves glucose up to 72 hours [not an anticoagulant but an additive]
- mode of action inhibits glycolysis by inactivating enolase (removes Mg 2)

Other additives:

Clot activator
*glass or silica – used in STAT serum determinations
*thrombin – usually present in orange top tubes

Gel separator
*a.k.a thixotropic gel
* usually present in gold top tube
Order of Draw

1. Blood culture tubes (yellow) [invert 8 times]

2. Coagulation studies; citrate tubes (light blue) [invert 3-4 times]
3. Serum tubes with or without clot activator or gel separator (red or gold) [invert 5 times
(w/additive) / 0 times (w/o additive)]
4. Heparin tubes (green) [invert 8 times]
5. EDTA tubes (lavender) [invert 8 times]
6. Glycolytic inhibitor fluoride tubes (grey) [invert 8 times]