Effect of magnesium contamination in evacuated blood collection tubes on the prothrombin time test and ISI calibration using recombinant human thromboplastin and different types of coagulometer.
The purpose of the present study was to assess the effect of two types of evacuated blood collection tube on the prothrombin time and international sensitivity index (ISI) of Recombiplastin, a recombinant human thromboplastin. Vacutainer tubes were compared with Venoject II tubes. Magnesium contamination was detected in the sodium citrate solutions contained in the Vacutainer tubes with concentrations ranging from 1.1 to 1.5 mmol/l. In contrast, magnesium ions could not be detected in the Venoject II tubes. The prothrombin ratio was decreased by contamination with magnesium ions and, hence, the ISI was increased. The magnitude of the effect of magnesium contamination on the ISI was influenced by the type of coagulometer and increased in the order: ACL Advance (3%), ACL-300 (4%), Electra-1000 (6%). The ISI bias is transmitted to the international normalized ratio (INR). In the case of the Electra-1000, the INR bias would be approximately 6% at INR 3.0 if the two types of blood collection tubes would be used without distinction. In a secondary study, the effect of magnesium contamination on the prothrombin time was assessed with the current World Health Organization international reference preparation for recombinant human thromboplastin (rTF/95). Magnesium chloride added to patients' blood (0.2 mmol/l) induced 2.3% reduction of the INR determined with rTF/95 and the manual technique.


CONCLUSIONS
The magnitude of the influence of blood collection tubes contaminated with magnesium on ISI and INR determined with recombinant human thromboplastin depends on the coagulometer.
van den Besselaar
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AM
Hemostasis and Thrombosis Research Center, Department of Hematology, Leiden University Medical Center, C2-R, P.O. Box 9600, Leiden 2300 RC, The Netherlands. A.M.H.P.van_den_Besselaar@lumc.nl
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D000925:Anticoagulants / Q000494:pharmacology*; D001800:Blood Specimen Collection / Q000295:instrumentation* / Q000592:standards / Q000706:statistics & numerical data; D002138:Calibration; D002951:Citrates / Q000032:analysis; D002985:Clinical Protocols; D004866:Equipment Contamination; D006801:Humans; D019934:International Normalized Ratio; D008274:Magnesium / Q000032:analysis / Q000494:pharmacology*; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000032:analysis / Q000592:standards; D012015:Reference Standards; D012680:Sensitivity and Specificity; D012964:Sodium / Q000032:analysis; D013925:Thromboplastin / Q000032:analysis* / Q000592:standards
D000925:Anticoagulants; D002951:Citrates; D011994:Recombinant Proteins; D013925:Thromboplastin; D012964:Sodium; D008274:Magnesium