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Clinical Chemistry 51: 424-433, 2005. First published December 2, 2004; 10.1373/clinchem.2004.043349
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(Clinical Chemistry. 2005;51:424-433.)
© 2005 American Association for Clinical Chemistry, Inc.

General Clinical Chemistry

Effect of Blood Collection Tubes on Total Triiodothyronine and Other Laboratory Assays

Raffick A.R. Bowen, Yung Chan, Joshua Cohen, Nadja N. Rehak, Glen L. Hortin, Gyorgy Csako and Alan T. Remaleya

Clinical Chemistry Service, Department of Laboratory Medicine, Warren Grant Magnuson Clinical Center, NIH, Bethesda, MD.

aAddress correspondence to this author at: Department of Laboratory Medicine, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bldg. 10, Rm. 2C-433, 10 Center Dr., Bethesda, MD 20892-1508. Fax 301-402-1885; e-mail aremaley{at}nih.gov.

Background: Increased total triiodothyronine (TT3) assay results in apparently euthyroid patients triggered an investigation of the effect of blood collection tubes on serum TT3 and other laboratory assays.

Methods: We examined potential assay interference for three types of tubes: plastic Greiner Bio-OneTM VacuetteTM; glass Becton Dickinson (BD) VacutainerTM; and plastic BD Vacutainer SSTTM tubes. Serum samples from apparently healthy volunteers (age range, 30–60 years; 15 males and 34 females) were collected in different tube types and analyzed in 17 immunoassays (n = 49), 30 clinical chemistry tests (n = 20), and 33 immunology assays (n = 15). Tube effects were also examined by adding pooled serum to different tube types.

Results: TT3 values, when measured by the IMMULITETM 2000 but not the AxSYMTM analyzer, were significantly higher (P <0.0001) for SST (2.81 nmol/L) than either glass (2.15 nmol/L) or Vacuette (2.24 nmol/L) tubes. The effect was large enough to substantially shift the distribution of patient values, increasing the percentage of values above the reference interval from 11.3% to 35.8%. The degree of interference from SST tubes on TT3 differed among various tube lots and could be attributed to a tube additive shared by other plastic tubes. Results from several other tests statistically differed among tube types, but differences were not considered to be clinically significant.

Conclusions: Assay interferences from blood collection tubes represent challenges to clinical laboratories because they are not detected by the usual quality-control or proficiency testing programs. Laboratories can, however, address this problem by monitoring distribution of patients’ results.




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Assay interferences from blood collection tubes: a cautionary note.
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S. Wang, V. Ho, A. Roquemore-Goins, and F. A. Smith
Effects of Blood Collection Tubes, including Pediatric Devices, on 16 Common Immunoassays.
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L. J. Kricka, J. Y. Park, M. B. Senior, and R. Fontanilla
Processing Controls in Blood Collection Tubes Reveals Interference
Clin. Chem., December 1, 2005; 51(12): 2422 - 2423.
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L. J. Kricka and J. Y. Park
Additive-Aggravated Assays: An Authoritative Answer
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R. A.R. Bowen, Y. Chan, M. E. Ruddel, G. L. Hortin, G. Csako, S. J. Demosky Jr, and A. T. Remaley
Immunoassay Interference by a Commonly Used Blood Collection Tube Additive, the Organosilicone Surfactant Silwet L-720
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D. T. Holmes, A. Levin, B. Forer, and F. Rosenberg
Preanalytical Influences on DPC IMMULITE 2000 Intact PTH Assays of Plasma and Serum from Dialysis Patients
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