Routine coagulation testing: do we need a discard tube?

Abstract

When coagulation tests are performed, the recommended guideline is that a discard tube be used and the coagulation testing should be done only on the second tube. This guideline is however inconsistently enforced and most laboratories follow a single tube draw for routine coagulation testing. Few studies have however, challenged this guideline and have shown that comparable results can be obtained in both tubes when a two tube draw is used. This prospective study was done over a 3months period in the hematology laboratory under the Clinical Hematology unit of a tertiary care teaching institution in North India. Fifty-six paired specimens were drawn from healthy volunteers following the prescribed "two tube draw" method. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were performed within 1h of sample collection on a fully automated photo-optical coagulation instrument (Ceveron-Alpha). Paired results for PT and APTT were compared using Bland-Altman plots for method comparison. There was good correlation between the PT, INR and APTT of the first and second tubes with bias of 0.09, -0.05 and 0.3 respectively). Bland-Altman plots showed acceptable agreement between the two values with 95% confidence interval ranging from -0.62 to 0.79 for PT, -0.05 to 0.06 for INR and -3.9 to 4.6 for APTT. Our study has shown no significant difference between PT and APTT values for the first and second tubes. Hence the use of a discard tube is not required.