{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T10:26:09Z","timestamp":1774261569115,"version":"3.50.1"},"reference-count":28,"publisher":"Walter de Gruyter GmbH","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_cclm-2019-0433_s_999_w2aab3b7d147b1b6b1aab1c16b1Aa\">\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Published evidence on the risk of additive carryover during phlebotomy remains elusive. We aimed to assess potential carryover of citrated and heparinized blood and the relative volume needed to bias clinical chemistry and coagulation tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2019-0433_s_998_w2aab3b7d147b1b6b1aab1c16b2Aa\">\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We simulated standardized phlebotomies to quantify the risk of carryover of citrate and heparin additives in distilled water, using sodium and lithium as surrogates. We also investigated the effects of contamination of heparinized blood samples with increasing volumes of citrated blood and pure citrate on measurements of sodium, potassium, chloride, magnesium, total and ionized calcium and phosphate. Likewise, we studied the effects of contamination of citrated blood samples with increasing volumes of heparinized blood on heparin (anti-Xa) activity, lithium, activated partial thromboplastin time (APTT), prothrombin time (PT) and thrombin time (TT). We interpreted these results based on measurement deviations beyond analytical, biological and clinical significance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2019-0433_s_997_w2aab3b7d147b1b6b1aab1c16b3Aa\">\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Standardized phlebotomy simulations revealed no significant differences in concentration of surrogate markers. Clinically significant alterations were observed after contamination of heparinized blood samples with volumes of citrated blood beyond 5\u201350 \u03bcL for ionized calcium and beyond 100\u20131000 \u03bcL for sodium, chloride and total calcium. Investigations of pure citrate carryover revealed similar results at somewhat lower volumes. Heparinized blood carryover showed clinically significant interference of coagulation testing at volumes beyond 5\u2013100 \u03bcL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_cclm-2019-0433_s_996_w2aab3b7d147b1b6b1aab1c16b4Aa\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our results suggest that during a standardized phlebotomy, heparin or citrate contamination is highly unlikely. However, smaller volumes are sufficient to severely alter test results when deviating from phlebotomy guidelines.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/cclm-2019-0433","type":"journal-article","created":{"date-parts":[[2019,8,4]],"date-time":"2019-08-04T13:15:41Z","timestamp":1564924541000},"page":"1888-1896","source":"Crossref","is-referenced-by-count":7,"title":["Heparin and citrate additive carryover during blood collection"],"prefix":"10.1515","volume":"57","author":[{"given":"Martin H.","family":"Keppel","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Auer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Lippi","sequence":"additional","affiliation":[{"name":"Section of Clinical Chemistry , University of Verona , Verona , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"von Meyer","sequence":"additional","affiliation":[{"name":"Institute of Laboratory Medicine, Kliniken Nordoberpfalz AG and Klinikum St. Marien , Weiden and Amberg , Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Cornes","sequence":"additional","affiliation":[{"name":"Biochemistry Department , Worcester Acute Hospitals NHS Trust , Worcester , UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas K.","family":"Felder","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannes","family":"Oberkofler","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelia","family":"Mrazek","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Haschke-Becher","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine , Paracelsus Medical University Salzburg , Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6200-9831","authenticated-orcid":false,"given":"Janne","family":"Cadamuro","sequence":"additional","affiliation":[{"name":"University Hospital Salzburg, Paracelsus Medical University , Department of Laboratory Medicine, Salzburger Landeskliniken , M\u00fcllner Hauptstr. 48 , 5020 Salzburg , Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2019,8,5]]},"reference":[{"key":"2023033110125151204_j_cclm-2019-0433_ref_001_w2aab3b7d147b1b6b1ab2b1b1Aa","doi-asserted-by":"crossref","unstructured":"Rohr UP, Binder C, Dieterle T, Giusti F, Messina CG, Toerien E, et al. 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