COMPARISON OF COMPLETE BLOOD COUNT PARAMETERS USING ETHYLENE DIAMINE TETRAACETIC ACID (EDTA) ANTICOAGULANT WITH LITHIUM HEPARIN AND SODIUM CITRATE ANTICOAGULANTS AMONG HEALTHY VOLUNTEERS: A LABORATORY-BASED CROSS-SECTIONAL ANALYTICAL STUDY

Abstract

Introduction: The Complete Blood Count (CBC) test is the most commonly requested laboratory test that has significantly contributed to the diagnosis and treatment of diseases in the fields of hematology and general medicine. However, though K₂EDTA is the anticoagulant suggested for hematological examination of blood, some other anticoagulants such as Lithium Heparin and Sodium Citrate have been used as an alternative to K₂EDTA when it cannot be used. In this research, there will be a comparison of parameters of CBC in K₂EDTA, Lithium Heparin and Sodium Citrate anticoagulated blood samples in order to assess their similarity and compatibility. Methodology: An analytical laboratory study was performed involving 110 healthy participants from February 2024 to March 2025. Blood samples from the participants were collected in K₂EDTA, Lithium Heparin, and 3.2% Sodium Citrate vacutainers and then tested with the Sysmex XP-300 automated hematology analyzer. The parameters tested included WBC count, RBC count, Hemoglobin (Hb), Hematocrit (HCT), Mean Corpuscular Volume (MCV), MCH, MCHC, and platelet count. Data analysis was performed using SPSS version 25.0 and R software. Comparisons were made using one-way ANOVA, while ICC and CCC were used to assess reliability and agreement. Results: Excellent reliability was reported for most CBC parameters, with ICC values ranging from 0.916 to 0.977, and Platelet count showed good reliability (ICC=0.806). A significant difference was noted between the three anticoagulants in relation to WBC, RBC, Hb, HCT, and platelet count (p<0.05), whereas MCV, MCH, and MCHC showed no significant difference. Sodium citrate had a better correlation with K₂EDTA than lithium heparin in most of the hematological parameters, especially WBC, RBC, Hb, HCT, and platelet count. Red cell indices had excellent agreement in all the anticoagulants. Conclusion: K₂EDTA is still the preferred choice for CBC. However, sodium citrate is more consistent with K₂EDTA than lithium heparin and can be an alternative anticoagulant in circumstances when EDTA is not available. Lithium heparin should be used with caution due to increased variability in certain hematological parameters.