Global Shortage in 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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