Sivasooriar Sivaneson: Every Drop of Blood Matters in Pre-Analytical Laboratory Quality
Sivasooriar Sivaneson, Senior Advisor and Consultant of Pathology, Senior Manager of the Core Laboratory at Gribbles Pathology, shared a post on LinkedIn:
“Every Drop Matters: The Hidden Impact of Underfilled Blood Collection Tubes
One of the most common yet underestimated pre-analytical errors is underfilled blood collection tubes. What may seem like a small issue can significantly affect result reliability due to an incorrect blood-to-additive ratio.
Here’s how underfilling can impact different sample types:
EDTA Tube (CBC – Purple Top):
Excess EDTA may alter blood cell morphology and counts, leading to:
- Falsely low MCV due to red cell shrinkage
- Falsely low hematocrit (HCT) values
- Platelet clumping
- Blood film artifacts affecting morphology interpretation
ESR Tube (Erythrocyte Sedimentation Rate):
An incorrect blood-to-anticoagulant ratio may produce:
- Falsely low ESR values
Plain / Serum Tube (Red/Yellow Top):
While generally more tolerant, underfilling may still result in:
- Inadequate serum volume for testing
- Poor clot formation or serum separation
Fluoride Tube (Grey Top – Glucose Testing):
Incorrect blood-to-additive ratios may impair glucose preservation and reduce the tube’s ability to adequately inhibit glycolysis, potentially causing:
- Low glucose results
Coagulation Tube (Blue Top – Sodium Citrate):
Most Critical
This tube depends on a strict 9:1 blood-to-anticoagulant ratio. Underfilling can cause:
- Falsely prolonged PT/INR and APTT
- Inaccurate D-dimer and coagulation factor results
- Misinterpretation of bleeding or anticoagulation status
The reality is simple: A high-quality analyzer cannot compensate for a poor-quality specimen.
Laboratory excellence is not only about analytical performance — it begins with proper specimen collection, correct fill volume, and strong pre-analytical quality practices.
A simple reminder to every healthcare professional involved in specimen collection:
Fill the tube to the mark — because every drop matters, and every result matters.”
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