The right blood collection tube for therapeutic drug monitoring and toxicology screening procedures: Standard tubes, gel or mechanical separator?

Clin Chim Acta. 2019 Jan:488:196-201. doi: 10.1016/j.cca.2018.10.043. Epub 2018 Nov 12.

Abstract

Stability data of toxics or drugs in gel-based or mechanical separation blood collection tubes are lacking, especially for therapeutic drug monitoring and clinical toxicology procedures. According to ISO 15189 accreditation standard, laboratories need to master the entire preanalytical process including the stability of analytes in a specific tube. Here we explored the impact of BD PST™ II and Barricor™ separator tubes on the stability of 167 therapeutic compounds and common drugs of abuse in plasma samples using LC-MS/MS. Forty drugs were significantly affected by the use of PST™ II tubes, including antidepressants (11/26), neuroleptics (9/13), cardiovascular drugs (5/26), anxiolytics and hypnotics (4/25) and some drugs of abuse (5/26). Six compounds exhibited significant reduction by the mechanical Barricor™ tubes. Ten drugs exhibited low (<85%) but non-significant recoveries due to inter-assay variability. Besides, a logP > 3.3 was determined as a cut-off value to predict a potential lack of stability in PST™ II gel tubes with an 86.4% sensitivity and a 61.4% specificity. As a consequence, determination of drugs with a logP > 3.3 should be carried out with caution in plasma samples withdrawn on PST™ II. The study showed the Barricor™ and non-gel tubes cause less drug interference and are recommended for the drugs studied.

Keywords: Blood collection tubes; Drug stability; LC-MS/MS; Plasma sampling; Separator gel; Therapeutic drug monitoring; Toxicology.

MeSH terms

  • Anti-Anxiety Agents / blood*
  • Antidepressive Agents / blood*
  • Blood Specimen Collection* / standards
  • Cardiovascular Agents / blood*
  • Chromatography, Liquid
  • Drug Evaluation, Preclinical
  • Drug Monitoring
  • Gels / chemistry
  • Humans
  • Hypnotics and Sedatives / blood*
  • Illicit Drugs / blood*
  • Tandem Mass Spectrometry

Substances

  • Anti-Anxiety Agents
  • Antidepressive Agents
  • Cardiovascular Agents
  • Gels
  • Hypnotics and Sedatives
  • Illicit Drugs