K2- Or K3-EDTA: The Anticoagulant Of Choice In Routine Haematology?

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Abstract

The choice of K2- or K3-EDTA as the preferred anticoagulant for blood count remains controversial. We compared the effect of different concentrations of both anticoagulants on normal blood. In optimal conditions (appropriate anticoagulant concentration and measurements done between 1 and 4 h after phlebotomy), no marked differences are seen between either EDTA salt. Important discrepancies appear, however, in less optimal conditions, as often happens in day to day practice. The packed cell volume, when measured on centrifuged blood, decreases with increasing anticoagulant concentrations and this is most pronounced with the K3 salt. This phenomenon has been reported by different authors and is ascribed to shrinking of erythrocytes in an hypertonic medium. Automated instruments react in a different way, their MCV is not influenced by K3-EDTA concentrations up to ten times normal, while K2-EDTA, at high concentrations, results in a slight increase in MCV, as measured with three of the instruments. With most instruments, the accuracy of the white cell count is not markedly influenced. However, when measured with the Unipath CD 3000 all tested blood samples, taken in high K3 (but not in K2) concentrations, showed an appreciable decrease in the leucocyte count (to less than 50% of the original value, at a concentration of 15 g/l, 24 h after blood collection). Measurement of RDW and automated differentials is also influenced by the choice of anticoagulant when determinations are done in less than optimal conditions. We conclude that the choice of anticoagulant, its use at an appropriate concentration and the age of the blood sample are important matters and should be given due consideration.(ABSTRACT TRUNCATED AT 250 WORDS)

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• Use of the Technicon H1 hypochromia flag in detecting spurious macrocytosis induced by excessive K2-EDTA concentration. Hinchliffe RF, Bellamy GJ, Lilleyman JS. Hinchliffe RF, et al. Clin Lab Haematol. 1992;14(3):268-9. doi: 10.1111/j.1365-2257.1992.tb00377.x. Clin Lab Haematol. 1992. PMID: 1451410 No abstract available.

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• EDTA-induced platelet aggregation can be avoided by a new anticoagulant also suitable for automated complete blood count. Lippi U, Schinella M, Nicoli M, Modena N, Lippi G. Lippi U, et al. Haematologica. 1990 Jan-Feb;75(1):38-41. Haematologica. 1990. PMID: 2110927
• False-positive flag of WBC and change of mean platelet volume (MPV) caused by K3-EDTA on the DxH 900 hematology analyzer. Park S, Huh J, Jeong TD. Park S, et al. Scand J Clin Lab Invest. 2020 Dec;80(8):644-648. doi: 10.1080/00365513.2020.1824298. Epub 2020 Sep 25. Scand J Clin Lab Invest. 2020. PMID: 32975447
• Evaluation of di-potassium and tri-potassium EDTA evacuated tubes for routine haematological testing. Mehmood R, Muhammed RK, Hussain S, Sana A. Mehmood R, et al. J Clin Lab Anal. 2018 Jan;32(1):e22188. doi: 10.1002/jcla.22188. Epub 2017 Feb 21. J Clin Lab Anal. 2018. PMID: 28220977 Free PMC article.
• The role of ethylenediamine tetraacetic acid (EDTA) as in vitro anticoagulant for diagnostic purposes. Banfi G, Salvagno GL, Lippi G. Banfi G, et al. Clin Chem Lab Med. 2007;45(5):565-76. doi: 10.1515/CCLM.2007.110. Clin Chem Lab Med. 2007. PMID: 17484616 Review.
• EDTA, the traditional anticoagulant of haematology: with increased automation is it time for a review? Reardon DM, Warner B, Trowbridge EA. Reardon DM, et al. Med Lab Sci. 1991 Jan;48(1):72-5. Med Lab Sci. 1991. PMID: 1905774 Review. No abstract available.

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