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Global Shortage in Sodium Citrate Tubes

Pandemic depletes inventories

by Dennis Ernst • June 09, 2021

Phlebotomy News

sodium citrate tubes

I'm not sure if you've felt the crunch yet, but manufacturers of blood collection tubes are in short supply of sodium citrates due to the Covid-19 pandemic. The supply chain disruption is affecting clinical laboratories around the world. 

Patients with severe Covid infections often experience pulmonary thromboembolism and other thromboses, which require continuous monitoring of coagulation factors. A massive and sustained spike in tests ordered to diagnose and monitor such coagulopathies---prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer, all collected into sodium citrate tubes---have severely depleted global inventories of blue top tubes in all sizes. 

According to a May 24 letter from Beckton Dickinson to their distributors, the demand for citrate products has been unprecedented due not only to Covid-19 infection rates but vaccine developments and treatments. As a result, the company has accelerated production of sodium citrate tubes, but warns of extended supply chain disruptions.

Austria-based global supplier Greiner Bio-One has also confirmed a shortage.

If the shortage has already impacted your facility, or even if it hasn't, I recommend taking the following steps immediately to reduce your facility's consumption of this valuable medical commodity until the global inventory is replenished:

  • Reduce or eliminate the collection of coagulation tubes when no coagulation tests are ordered. Drawing extra tubes just in case ("rainbows") is a wasteful practice at any time, much less during a pandemic-induced supply disruption. Studies have shown that only 4% of extra tubes collected in anticipation of tests that might be ordered are ever used.
  • Do not use coag tubes as a discard tube. Plain non-additive tubes like the BD Vacutainer® Z Plus tube and the Greiner Vacuette® Z tube are in plentiful supply and should be used. 
  • Change testing methodologies by using point-of-care testing platforms to monitor routine coagulation parameters;
  • Use smaller volume sodium citrate tubes, such as 1.8 mL, when possible.

Being wise stewards of your resources means planning for shortages like the one happening right now. There's no need to waste your precious supply of blue tops on frivolous usage like drawing rainbows and using citrates for discard tubes. You certainly don't want to be in a position where you have to pay top dollar for what used to be reasonably priced because you're desperate and without options. Rest assured tube manufacturers are feverishly increasing their output, but reducing unnecessary consumption is prudent even without a pandemic obliterating the supply.

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MT ASCP Supervisor

1.8 sodium citrate tubes were the first shortage we experienced. It is my understanding these are not being manufactured so as to concentrate on production of the 2.7.

Karen Nelson, 06/17/2021 10:15:35

Recommended POC devices

I am hear this recommendation continuously. Yet, people are not inputting the types and names of these devices. Also what about the recurrent proprietary consumables? Please advise

Ray Ramirez, 06/18/2021 14:56:14

POC devices

Ray Ramirez, here's a link to a coag POC product summary listing 8 or so products. Please clarify your question on "recurrent proprietary consumables."

Dennis Ernst, 06/21/2021 09:20:45


Ok i'm having problems understanding why they meaning BD, Griener, haven't ramped up production of these tubes, so you want me to believe that no one at any of these tube companies had enough foresight to amp up production when they understood that covid-19 caused clots in the lungs.

Isn't this a lack of knowledge in the medical community or the government agency CDC? Please help me understand.

Lizzie Hogan-Berry, 06/23/2021 21:34:31

CMS Letter OK to use expired blue tops

Hi Dennis, I called CAP for guidance on how to address the shortage of blue tops and was told there is a CMS letter posted giving permission to use expired tubes as long as it is reviewed and accepted by the Laboratory Director. Have you seen this letter? I am unable to located it on the CMS website. Thank you.

Patty Eschliman, 06/30/2021 12:28:54

No evidence yet of CMS approval to use expired citrate tubes

Thank you, Patty, for the feedback. I did some more research on this and I am unable to find solid evidence that CMS has approved the use of expired sodium citrate tubes for diagnostic or therapeutic dosage purposes. In fact, as recently as June 16, CAP posted an article on the shortage and made no mention of CMS, only that the FDA has listed sodium citrate tubes on their "Device Shortage List" for the pandemic. Here's the article:

Laboratories should not use expired sodium citrate tubes until and unless it has been firmly established that this rumor is true. Perhaps you could reach out your CMS contact, Patty, and see if he/she can point you to an official CMS notification. Thanks for your comment.

Dennis Ernst, 07/01/2021 07:55:00

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