‫كلية البصرة للعلوم والتكنلوجيا‬

‫قسم تقنيات المختبرات الطبية‬

Clinical Biochemistry
4th Year
Lecture
SPECIMENS COLLECTION

M.Sc. Duaa Safaa

Urine preservative:
They are used to reduce bacteria action or solubilize the constituents
precipitated in urine, or some time to decrease oxidation of unstable
compounds.
Refrigeration is one of the acceptable ways of urine preservation.
Toluene is still used as preservative, it act as a barrier between air and
specimen.
Feces:
Trypsin activity to children feces used for cystic fibrosis. Fecal nitrogen
and fat in 72 hrs. is used to assess malabsorption.
Cerebrospinal fluid (CSF):
CSF is an ultra filtrate of the plasma and it reflect the values seen in the
plasma like glucose, protein and LDH analysis.
Normal obtained by lumbar puncture. All fluid samples should be
handled immediately without delay between sample taking transport and
analysis.
• The color and other characteristics of the fluid should be noted before
centrifugation. The three collected tubes, the first tube should be for
chemical or serological tests, the second for microbiological tests, and
the third for cytological examinations.
Cerebrospinal fluid (CSF):
Decreased CSF glucose levels can be the result of active metabolism of
glucose by cells or organisms.

Synovial Fluid:
Obtained by arthrocentesis to assess arthritis types and to differentiate
inflammatory effusion from non-inflammatory fluid. Sterile plain tube
use for molecular diagnosis, culture, glucose and protein
measurements.
Amniotic fluid
Amniotic fluid is used to assess fetal lung maturity or congenital
diseases, hemolytic diseases, genetic defects, and gestational age.

Specimen Collection Tubes and Anticoagulants

- Collect the specimen into the proper tube or container, wrong container
can result in wrong results.
- Collect the required amount of specimen. Optimum volumes allow the
test to be repeated and verified if necessary.
- When using tubes with anticoagulants, especially for coagulation tests,
sufficient fill volume is required to ensure the appropriate specimen
dilution.
 Collection Tubes
Green-Top Tube: Contains Sodium, Potassium or Lithium salt of Heparin.

It prevents fibrin formation from fibrinogen by accelerating the action of anti-

thrombin
III (inhibiting thrombin activity).
- It causes least interference except with PCR.
- It cause false high free T3 and free T4 and inhibit acid phosphatase activity.
- The advantage of plasma is that no time is wasted waiting for the specimen to clot.
- Avoid contamination from heparin with coagulation tests.
- This anticoagulant is widely used for biochemistry tests (ABG, Ammonia, trace
elements, enzymes, hormones......)
Lavender (Purple) -Top Tube: EDTA (Ethylene Diamine Tetra acetic
Acid)

- It is chelating agent, inhibits coagulation by chelating calcium which is

essential for clot formation.
- EDTA is the potent anticoagulant used for most hematology procedures
(CBC).
- Used for some chemistries. E. g: HbA1C, G6PD, ACTH level….
- Can also be used for some blood bank procedures. EDTA tubes are
preferred by most molecular genetics laboratories (DNA or RNA).
Blue -Top Tube / Sodium Citrate (Na Citrate):

- It is a chelating agent for calcium. It is used for coagulation because its

action is easily reversed by calcium, mixed with blood in a ratio of 1:9
parts of blood.
- Additive: Heparin (Sodium/Lithium/Ammonium)
- E. g: ESR, Coagulation screen, prothrombin time (PT), INR,
fibrinogen.
Red-Top Tube
The red bottle is less common. It is used for collecting serum which
might be adversely affected by the separator gel.
- 10- 15 minutes is required to allow blood to clot before centrifuging.

Additive: None anticoagulants or preservatives (glass); contains silica

particles (plastic) which act as clot activators.
- Used for many chemistry tests, drug levels, and blood bank
procedures.
Grey-Top Tube:

Used for glucose measurement. After blood collection, glucose

concentration decrease significantly because cellular metabolism.
Additive: Grey-Top tube contains either:
Fluoride oxalate , potassium oxalate , Sodium oxalate

Laboratory uses: Chemistry testing, especially glucose and lactate,

Glucose tolerance test (GTT).
Gold-top tube/serum separator tube (SST):
It has no anticoagulant. 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.

This tube are used for a huge variety of tests, E. g: biochemistry,

endocrinology, oncology, toxicology, microbiology and immunology.
Black top tube: Na citrate, Ca Chelating agent, ESR