DIFFERENT COLORS OF BLOOD

COLLECTION VIALS
• MUNIZA MUNIR
• ROLL NO 10
• HUMAN NUTRITION & DIETETICS
• (3RD SEMESTER)
• ASSESSMENT OF NUTRITIONAL STATUS
• SUBMITTED TO: SIR NADEEM
 BLOOD COLLECTION TUBES
• 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.
 PURPLE BLOOD BOTTLE
• Purple blood bottles are generally used for hematology tests where whole blood is required
for analysis.
ADDITIVE:
• Purple blood bottles contain EDTA (ethylenediaminetetraacetic acid), which acts as a potent
anticoagulant by binding to calcium in the blood. EDTA also binds metal ions in the blood
and is used in chelation therapy to treat iron, lead or mercury poisoning. Its blood-binding
capacity also means it can be labelled with radioisotopes and used as an EDTA scan to assess
renal glomerular filtration rate
 COMMON TESTS

• Common tests performed using the purple blood bottle include:

• Full blood count (FBC)

• Erythrocyte sedimentation rate (ESR)
• Blood film for abnormal cells or malaria parasites
• Reticulocytes
• Red cell folate
• Monospot test for EBV
• HbA1C for diabetic control
• Parathyroid hormone (PTH)*
 TIPS FOR USING PURPLE BLOOD BOTTLE
• The purple tube needs inverting about 8 times to mix the sample with the EDTA. About 1ml
of blood is sufficient to perform a full blood count, however, to get an ESR you will need a
full purple bottle.
 PINK BLOOD BOTTLES
• The pink bottles work in the same way as the purple ones but are specifically used only for
whole blood samples being sent to the transfusion lab.
ADDITIVE:
• Pink blood bottles also contain the anticoagulant EDTA.
 COMMON TESTS
• Common tests performed using the pink blood bottle include:

• Group and save (G&S): this simply means the patient’s blood is typed and tested for
antibodies, then saved in the lab in case it is required; it DOES NOT get you blood products
for transfusion.
• Crossmatch (XM): this means that the patient’s blood is typed and tested as above, then
matched to specific units of blood, platelets or other products for transfusion. You need to
specify on the form how many units you need, why you need them and when they are
required. A full crossmatch takes about 45-60 minutes in the lab – if you have an unstable
bleeding patient you can use their stocks of O negative blood from the fridge.
• Direct Coomb’s test (a.k.a. direct antiglobulin test) for autoimmune haemolytic anemia.
 TIPS FOR USING PINK BLOOD BOTTLE
• The pink tube needs inverting about 8 times to mix the sample with the EDTA. It should
contain at least 1ml of blood, but more is preferred by the labs if at all possible. It has a
special label which needs to be carefully filled in by hand at the bedside to ensure the correct
patient details are used, preventing potentially catastrophic mismatched blood transfusions.
If you need blood for a patient urgently or have any unusual or complicated requests, you
must ring the transfusion lab and let them know, or you risk invoking their wrath.
 BLUE BLOOD BOTTLE
• The blue bottle is used for haematology tests involving the clotting system, which require
inactivated whole blood for analysis.
ADDITIVE:
• Blue blood bottles contain buffered sodium citrate, which acts as a reversible anticoagulant
by binding to calcium ions in the blood and subsequently disrupting the clotting cascade.
Sodium citrate is also added to blood products for transfusion and acts as a preservative by
stopping them from clotting in the bag.
 COMMON TESTS

• Common tests performed using the blue blood bottle include:

• Coagulation screen: including bleeding time for platelet function, prothrombin time for
assessment of the extrinsic pathway, activated partial thromboplastin time for assessment of
the intrinsic pathway, and a thrombin time or fibrinogen assay for assessment of the final
common pathway.
• D-dimer to assist with ruling out thrombosis (e.g. deep vein thrombosis).
• INR for monitoring patients on warfarin (this is calculated from the prothrombin time).
• Activated partial thromboplastin ratio (APTR) for monitoring patients on intravenous
heparin infusions (this is calculated from the APTT).
 TIPS FOR USING BLUE BLOOD BOTTLE
• The blue bottle needs to be inverted 3-4 times to mix the sample with the anticoagulant. The
sodium citrate liquid in the bottle dilutes the blood sample, and the machines in the lab are
specifically calibrated to interpret results based on a set ratio of blood to anticoagulant. It is,
therefore, essential that the bottle is filled to the line marked around its edge to ensure the
tests are interpreted accurately – otherwise, the samples may be over-anticoagulated.
 YELLOW BLOOD BOTTLE
• These are used for separated serum for analysis, including biochemistry, endocrinology,
oncology, toxicology, microbiology and immunology.
ADDITIVE:
• This tube is known in the lab as the SST (serum separating tube). It contains two agents;
silica particles and a serum separating gel. The silica particles work to activate clotting and
cause the blood cells to clump together. The serum separator consists of an inert polymer gel
which floats as a layer between the blood cells and plasma to form a physical barrier
between them. This means that the sample can be centrifuged (spun) in the lab and the
separated serum easily removed.
 COMMON TESTS
Biochemistry tests:
• Urea and electrolytes (U&Es), C-reactive protein (CRP), Liver function tests(LFTs): this
includes bilirubin, ALP, AST/ALT, GGT, Amylase assay, Bone profile, Iron studies, Lipid
profile, Thyroid function tests (TFTs), Vitamins, Troponins. Serum osmolality.
Endocrinology tests:
• Beta-hCG, Calcitonin, Cortisol, EPO, Sex hormones, Growth hormone, IGF-1
Toxicology tests:
• Ethanol, Cannabis, Opiates Benzodiazepines
Drug level tests:
• Paracetamol, Salicylates (aspirin), Digoxin, Lithium, Gentamicin, Carbamazepine
Microbiology/virology tests
• The yellow blood bottle can be used to test for a wide variety of bacterial, viral, fungal and
parasitic infections including HIV and viral hepatitis.
Immunology tests:
• Immunoglobulin levels, Complement levels, Autoantibody screen, Rheumatoid factor,
Thyroid antibodies, ACE.
Tumor marker tests:
• PSA, CEA, CA-125, CA19-9, AFP, Lactate dehydrogenase (LDH)
 TIPS FOR USING YELLOW BLOOD BOTTLE
• The yellow bottle needs to be inverted about 5 times to mix the sample with the silica and
separator. Don’t panic if the blood starts to clot or separate in the bottle, it’s supposed to!
The amount of blood required will depend on how many tests you’re doing, but at least 1ml
is ideal. You can usually get about 12 tests from one full yellow bottle. Remember that
different labs may be located in different areas and technicians don’t like sharing – this
means you’ll need to put your biochemistry and microbiology samples in separate yellow
bottles to go to their respective laboratories.
 GREY BLOOD BOTTLE
• The grey bottle is only used for two tests, so compared to the yellow one it’s fairly easy to
remember! It is used for biochemistry tests requiring whole blood for analysis.
ADDITIVE:
• Contains two main agents. Sodium fluoride acts as an antiglycolytic agent to ensure that no
further glucose breakdown occurs within the sample after it is taken. Potassium oxalate acts
as an anticoagulant. Some variants of the grey bottle use EDTA as the anticoagulant instead.
 COMMON TESTS
• Glucose: this can be fasting or non-fasting, or part of a glucose tolerance test (GTT),
Lactate.

TIPS FOR USING GREY BLOOD BOTTLE:

• The grey bottle needs to be inverted about 8 times to mix the sample with the fluoride and
oxalate. Only a tiny amount of blood is required for a glucose test, but to assess lactate levels
the bottle should ideally contain at least 1ml of blood.
 RED BLOOD BOTTLE
• The red bottle is less common – it is used for biochemistry tests requiring serum which
might be adversely affected by the separator gel used in the yellow bottle.
ADDITIVE:
• The additive in red blood bottles contains silica particles which act as clot activators.
 COMMON TESTS
• The use of this bottle varies greatly, some hospitals use it for many sensitive tests, including
hormones, toxicology, drug levels, bacterial and viral serology and antibodies.

TIPS FOR USING RED BLOOD BOTTLE:

• The red bottle needs inverting 5 times to mix the sample with the clot activator. There is also
another version of the red bottle made out of glass, which contains no additives whatsoever.
 DARK GREEN BLOOD BOTTLE
• This less commonly used bottle is for biochemistry tests which require heparinized plasma
or whole blood for analysis.
ADDITIVE:
• The additive of dark green blood bottles contains sodium heparin, which acts as an
anticoagulant.
 COMMON TESTS
• Ammonia
• Insulin
• Renin and aldosterone

TIPS FOR USING DARK GREEN BLOOD BOTTLE:

• The green bottle needs to be inverted about 8 times to mix the sample with the heparin. This
bottle cannot be reliably used to assess sodium levels.
 LIGHT GREEN BLOOD BOTTLE
• This rare species of blood bottle is used for biochemistry tests requiring separated
heparinized plasma.
ADDITIVE:
• This bottle is known as the plasma separator tube (PST). It contains lithium heparin, which
acts as an anticoagulant, and a plasma separator gel similar to that used in the yellow bottle,
which acts to separate out the plasma layer.
 COMMON TESTS
• It can be used for routine biochemistry, but most hospitals seem to use the yellow bottle for
this. It can also be used for blood ethanol provided the sample is not for legal purposes.

TIPS FOR USING LIGHT GREEN BLOOD BOTTLE:

• The light green bottle needs inverting about 8 times to mix the sample with the heparin and
separator. This bottle cannot be reliably used to assess lithium levels.
 OTHER BLOOD BOTTLES
• These other blood bottle types include:
• Dark blue: used for toxicology and trace elements such as zinc, selenium and copper.
• Tan: used to test for lead.
• Orange: contains a thrombin-based clot activator which allows stat serum testing.
• Light yellow: used for HLA phenotyping, tissue typing, DNA analysis and paternity testing.
• White: used for molecular diagnostics such as PCR and DNA amplification studies.
• Black: for paediatric ESR.
• Clear lid: used as a discard tube, for example when taking blood from a central line.