Determining the effect of freezing on coagulation testing

The accuracy of the results from coagulation testing can be affected by numerous preanalytic and analytic variables including the stability of the citrated sample at room temperature. Samples not tested within 2-4 h of collection should be processed and frozen for later analysis. As limited data exist about the impact of freezing samples on coagulation testing, we sought to evaluate the effect of freezing on coagulation testing. Plasma samples into 3.2% sodium citrate tubes, centrifuged to yield platelet-poor plasma, were evaluated for prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, D-dimer, antithrombin (AT) activity, factors V, VII, VIII, IX, lupus anticoagulant and anti-Xa measurements for both unfractionated and low-molecular-weight heparins. Samples were then frozen at -70°C for at least 1 week and testing was repeated using the same lot of material. All tests strongly correlated (R > 0.85) between fresh and frozen sample results. Using paired t test analysis, significant differences between fresh and frozen tested plasma existed for PT, APTT, factors V, VIII and AT. Significant differences existed between fresh and frozen lupus anticoagulant ratios (lupus anticoagulant screen but not lupus anticoagulant confirm), and single centrifugation process underestimated the presence of lupus anticoagulant as compared to double centrifugation processing. Freezing significantly affects the results for PT, APTT, factors V and VIII activity, and AT activity, although these differences were not considered to be clinically significant. Double centrifugation is required for accurate lupus anticoagulant testing, regardless of whether platelet-poor plasma is achieved with single centrifugation.