Dear Mailbase,
Some readers might find the below information useful from David Bruns (who also wrote the editorial quoted in my former letter below). David is happy to share his comments with the audience of the Mailbase.
I have also contacted BD and as soon as I get any useful info from them, I will share it with the mailbase.
Regards, Rita
Prof. Andrea Rita Horvath
Clinical Director
SEALS North, Department of Clinical Chemistry
Level 4, Campus Centre, Prince of Wales Hospital
Barker Street, Randwick, NSW 2031, Sydney, Australia
Tel: (+612)-9382 9078
Fax: (+612)-9382 9099
Mobile No: (+61)-404 027 843.
Letter from David Bruns:
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Thanks, Rita.
I heard that BD is planning to market the acid citrate tubes that will really stabilize glucose. If they do, we will have created another problem: The glucose concentrations that are used as cutpoints for diagnosis of diabetes were determined based on analysis of samples that did not have such good stabilization of glucose.
From what I have been able to learn about how samples were handled in earlier studies, I suspect that quite a lot of glucose was lost before the samples were analyzed. By contrast, sample handling in clinical labs has improved dramatically. For example, when NaF and serum tubes were compared in routine use 40 years ago, the glucose concentrations differed dramatically between the two. This indicates that the routine processing of samples took well over 90 minutes. When the same study was repeated 10 years ago by the same people (John Savory and Gerry Heintges), there was no discernable difference in glucose results between the two tube types. What changed? Samples reached the laboratory much more quickly in the more recent study and were processed much more quickly (mostly in response to pressure to shorten turnaround times, nothing to do with glucose).
Now things are getting even better: For one thing, there is even more pressure to decrease turnaround times and labs are responding. Secondly, blood collection tubes contain barrier gels that separate the plasma from the glycolytic enzymes in the cells. Thirdly, I have heard (have not confirmed) that Quest is getting its labs to spin samples according to a protocol that essentially happens to match our recommendations.
The result of all these improvements is that the measured glucose concentrations in clinical practice are increasing. This will increase the number of people diagnosed with diabetes. In fact, it probably has already.
I find this interesting, but may be the only person who does.
Cheers,
David
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-----Original Message-----
From: Webster Craig [mailto:[log in to unmask]]
Sent: Thursday, 18 August 2011 5:51 PM
To: Rita Horvath
Cc: <[log in to unmask]>
Subject: Re: Place samples in ice-water ...
My thanks, I read the references quoted and found the company in question. They do indeed seem to distribute in Europe.
Best Wishes
Craig
Craig Webster
Consultant Clinical Scientist
Birmingham Heartlands Hospital
Birmingham
B95SS
On 18 Aug 2011, at 04:03, Rita Horvath wrote:
>
> I was asked by some readers what we know about the availability of the citrate-NaF-EDTA tube. The guideline cites the below two references which provide further information on this.
>
> Bruns DE, Knowler WC. Stabilization of glucose in blood samples: why it matters. Clin Chem 2009;55:850-2.
>
> Gambino R, et al. Acidification of blood is superior to sodium fluoride alone as an inhibitor of glycolysis. Clin Chem 2009;55:1019-21.
>
> From the latter paper I quote the relevant information which might be of help:
> "Terumo Medical Corporation manufactures a blood-collection tube (Venosafe(r) Glycaemia) that contains the ingredients identified in the patent. These ingredients are a granular mixture of a citrate buffer, NaF, and disodium EDTA with a combined mass of 7.5 g/L of blood. Terumo does not specify the ratios of the ingredients. Moreover, we found no published study of this acidified Terumo blood-collection tube for measuring blood glucose concentrations. This tube is available in Europe but not in the US. We were able to obtain samples of the tube containing the acidification reagents, for experimental use only, through our laboratory in the UK."
>
> I wish to declare no commercial interest in the named company or any other tube supplier.
>
> Regards, Rita
> Prof. Andrea Rita Horvath
> Clinical Director
> SEALS North, Department of Clinical Chemistry
> Level 4, Campus Centre, Prince of Wales Hospital
> Barker Street, Randwick, NSW 2031, Sydney, Australia
> Tel: (+612)-9382 9078
> Fax: (+612)-9382 9099
> Mobile No: (+61)-404 027 843.
>
>
> ---------------------------------------------------------------------------------------------
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