Akademik Veri Yönetim Sistemi
XXXIII. WASPaLM World Congress & XXIV. National Clinicial Biochemistry Congress, Antalya, Türkiye, 16 - 20 Ekim 2024, ss.127
Aim: The total testing process is divided into three phases: preanalytical, analytical, and
postanalytical. Studies show that approximately 70% of errors occur in the preanalytical phase. One of
the errors encountered during this period is collecting samples in the wrong tube. It is very difficult to
reject CSF (cerebrospinal fluid) samples which are put in serum tubes because they are obtained by
risky interventional procedure and sufficient literature information is insufficient. Due to the difficulty
in obtaining sufficient amounts of CSF samples, this study aims to evaluate the effects of different
tube types on tests typically performed in CSF analyses by using serum samples as a surrogate.
Method: Twenty serum samples were included in the study. Each sample was divided into three parts:
placed in a blank container, a Becton Dickinson (BD) Vacutainer SST II Advance 8.5 mL tube, and a
Greiner Bio-One Vacuette Tube 8 mL Cat Serum Clot Activator tube. The tubes were inverted to
ensure contact between the serum and the tube walls. After a 30-minute waiting period, the tubes were
inverted again, and albumin, total protein, glucose, alanine aminotransferase, creatinine, sodium,
potassium, chlor levels were measured using the Cobas 702 (Switzerland) biochemistry analyzer in
our laboratory. The results obtained from different tubes were compared. Additionally, to lower the
protein and albumin levels to CSF levels, the samples in the blank container were diluted 1/60, and 0.5
mL of these diluted samples were placed in the blank container, the Becton Dickinson (BD) Vacutainer
SST II Advance 8.5 mL tube, and the Greiner Bio-One Vacuette Tube 8 mL Cat Serum Clot Activator
tube. Microalbumin and CSF-urine protein levels were measured from each of these samples. The
results were compared to determine the effect of using different tubes on laboratory test results.
Results: No statistically significant difference was found between the blank container, Becton
Dickinson (BD), and Greiner tubes in terms of serum parameters (p>0.05). In the samples diluted
1/60, no significant difference was found in microalbumin concentrations among the three different
tubes. In terms of total protein concentrations, there was no statistically significant difference between
the blank container and Becton Dickinson (BD) tubes (p=0.567), but the total protein concentration
measured in the Greiner tube was significantly lower than in the blank container and Becton
Dickinson (BD) tubes (p<0.0001 for both).
Conclusion: Collecting CSF in tubes containing gel separators can significantly alter CSF protein
levels due to the presence of tube components (clot activator, gel, etc.). As this can affect patient
diagnosis and treatment management, it is recommended that CSF samples be collected in additivefree
tubes.
Keywords: Cerebrospinal fluid proteins, Blood specimen collection, Specimen Handling, Serum
albumin.