© International Epidemiological Association 2003 Printed in Great Britain International Journal of Epidemiology 2003;32:125–130

DOI: 10.1093/ije/dyg023

METHODOLOGY

Stability of plasma analytes after delayed

separation of whole blood: implications for
epidemiological studies
Sarah Clark,1 Linda D Youngman,1,2 Alison Palmer,1 Sarah Parish,1 Richard Peto1 and Rory Collins1

Accepted 3 October 2002

Background Large blood-based epidemiological studies require simple, cost-effective sample

collection methods. Immediate sample separation or rapid transport of chilled
blood samples to a central laboratory may be impractical or prohibitively ex-

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pensive. To assess the feasibility and reliability of transporting blood samples over
several days at ambient temperature (e.g. by mail), we evaluated the stability of
various plasma analytes in samples stored at room temperature or chilled.

Methods Multiple vacutainers of blood, containing EDTA and aprotinin as preservative,

were drawn from 12 volunteers and stored at 21°C or 4°C. Immediately after col-
lection and 1, 2, 3, 4, and 7 days later, vacutainers stored at each temperature were
centrifuged, and the plasma was aliquoted and stored at –80°C. Subsequently, all
aliquots from each individual were analysed in one analytical run for a range of
chemistries.

Results In whole blood stored at room temperature for up to 7 days, concentrations of

albumin, apolipoproteins A1 and B (apoA1 and apoB), cholesterol, high density
lipoprotein (HDL), total protein, and triglycerides changed by less than 4%, and
low density lipoprotein (LDL) by less than 7%. Whilst alanine transaminase
(ALT), creatine kinase (CK), creatinine, and γ-glutamyl transferase (GGT) concen-
trations changed substantially at room temperature, there was less than 4% change
during chilled storage up to 7 days. By contrast, aspartate transaminase (AST) con-
centrations increased markedly under both conditions.

Conclusions A wide range of important analytes, including lipids, change by only a few per
cent in whole blood during storage at room temperature for several days. Mailed
transport of whole blood samples may, therefore, be a simple and cost-effective
option for large-scale epidemiological studies.

Keywords Analytes, blood-based epidemiology, blood collection, stability, temperature

Observational epidemiological studies can often be greatly
enhanced by the inclusion of biochemical analyses in stored
blood samples collected from the population being studied.
Biochemical analyses can be used to assess risk factor exposure,
to control for confounding, or to measure the effects of bias.
In randomized trials, biochemical analyses can be used to
monitor the safety and biochemical efficacy of treatment. For
1 Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Depart-
ment of Clinical Medicine, University of Oxford, UK.
2 Current affiliation: FDA Office of Research, Laurel, MD 20708, USA.
epidemiological studies to be informative, they often need to be
large (perhaps involving tens or hundreds of thousands of indi-
viduals), which in turn requires methods for blood collection
that are practical and cost-effective. Standard guidelines for
blood sample handling state that plasma or serum should be
separated from cells as soon as possible and certainly within
2 hours.1 Whilst this is necessary for particular analytes, it
might be assumed that many blood analytes deteriorate within
a matter of hours in unseparated samples kept at ambient
temperature. This perceived need for either immediate local
separation of blood samples or their rapid chilled transfer to

125
126 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
a central laboratory, which increases complexity and cost, can
prevent blood collection from being included in large-scale
epidemiological studies.
Particularly when blood samples are being collected in a large
number of separate sites within a study, mailing of whole blood
samples to a central laboratory for separation may be more
convenient and cost-effective than making arrangements for
local separation or for courier transport of chilled samples. Saliva
samples have been successfully collected by mail for measure-
ment of hepatitis B virus seropositivity2 and the potential advant-
ages of collecting blood samples by mail in epidemiological
studies have been noted.3 There is limited evidence to suggest
that some biochemical analytes (such as total cholesterol) may
be stable in whole blood for several days at ambient temperature.4–6
If confirmed for a wider range of analytes of interest, use of
mailed whole blood samples might allow blood collection to be
included in studies where it would not otherwise be considered
feasible. We have evaluated the use of mailed whole blood
samples and of chilled samples (compared with immediate plasma
separation) by simulating these two collection methods in the
laboratory, and assessing their impact on the stability of a range
of blood analytes.
Materials and Methods
Subjects and procedures
Twelve 10 ml vacutainers of blood containing 0.12 ml
preservative (15% potassium EDTA with aprotinin 0.34 mmol/l
[Becton Dickinson UK Limited, Oxford, England]) were drawn
from each of 12 non-fasting volunteers (5 males and 7 females,
aged 25–60 years). Each vacutainer corresponded to a particular
storage temperature (room temperature or chilled) and separation
time-point (immediate or 1, 2, 3, 4, or 7 days post-collection),
which were randomly assigned within each volunteer’s set of
vacutainers using a random number table.
Two of the 12 vacutainers from each individual were centri-
fuged immediately after collection (2100 g for 15 minutes at
4°C), and the plasma was aliquoted into 1.8 ml Nunc cryotubes
(Nunc A/S, Roskilde, Denmark) and stored at –80°C. The
remaining 10 vacutainers from each individual were covered
in aluminium foil to prevent any potential effect from light
(since samples would be unlikely to be exposed to light during
transportation) and kept at room temperature (defined as 21°C)
or chilled (4°C). At each subsequent time-point, a vacutainer
from each temperature for each volunteer was retrieved, centri-
fuged and the plasma aliquoted and stored at –80°C. (An
on-going study in our laboratory has found no change in
concentrations of any of the analytes in plasma samples stored
at –80°C during up to 5 years.)
Biochemical analyses
Prior to analysis, the frozen samples were left to stand at room
temperature to thaw, then inverted several times to mix. The
plasma aliquots from all temperature and time-points for each
volunteer were analysed together in one batch, to avoid run-to-
run variability, for the following analytes: alanine transaminase
(ALT), albumin (by the bromocresol purple method), apolipo-
proteins A1 and B (apoA1 and apoB), aspartate transaminase
(AST), creatine kinase (CK), creatinine (by the Jaffe rate method),
γ-glutamyl transferase (GGT), high density lipoprotein (HDL),
low density lipoprotein (LDL), total cholesterol, total protein
(by the rate biuret method), and triglycerides. Measurements
were performed on a Synchron LX20 autoanalyser (Beckman
Coulter UK Limited, High Wycombe, England), using Beckman
Coulter reagents, calibrators, and controls for all assays, except
for HDL and LDL which were analysed using N-geneous reagents,
calibrators, and controls (Bio-Stat Limited, Stockport, England).
These direct methods for quantification of HDL and LDL were
fully automated, involving chemical isolation of the lipoprotein
and enzymatic measurement of cholesterol. The Synchron
LX20 autoanalyser monitors absorbance readings at multiple
wavelengths and was programmed to subtract a sample blank
absorbance reading from the final reaction absorbance where
possible.7 This helps to correct for interference from colour in
plasma due to haemolysis, which was a significant problem in
samples from the later time-points. The intra-assay coefficient
of variation (CV) for ALT was 4% at a quality control level of
24.0 U/l and 1% at a quality control level of 84.3 U/l; for albumin
was 1% at 29.3 g/l and 2% at 47.2 g/l; for apoA1 was 3% both
at 83.9 mg/dl and 279.7 mg/dl; for apoB was 4% both at
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95.7 mg/dl and 200.9 mg/dl; for AST was 3% at 29.8 U/l and
1% at 100.4 U/l; for CK was 3% at 56.9 U/l and 1% at 394.0 U/l;
for creatinine was 9% at 73.6 µmol/l and 3% at 325.1 µmol/l;
for GGT was 7% at 20.1 U/l and 3% at 107.4 U/l; for HDL was
5% both at 0.7 mmol/l and 2.2 mmol/l; for LDL was 5% both
at 2.5 mmol/l and 5.6 mmol/l; for cholesterol was 2% both at
4.3 mmol/l and 9.9 mmol/l; for total protein was 1% both at
45.7 g/l and 73.7 g/l; for triglyceride was 3% both at 2.0 mmol/l
and 4.7 mmol/l.
Data analysis
For each individual, the mean analyte concentration from
analysis of the two samples that had been separated and frozen
immediately was used as the baseline ‘fresh’ value against which
analyte concentrations at future time-points were compared.
The stability of an analyte under each temperature condition
was determined by calculating the percentage change in con-
centration from the mean fresh value at each time-point for
each individual, then calculating the mean percentage change
from fresh (and standard error of the mean) at each time-point
from the individual data. Log-linear regression, incorporating a
term for individual, was used to determine the percentage change
per day for each analyte in samples kept at room temperature
and chilled; to test for significant differences in analyte concen-
trations between storage temperatures; and to test for signifi-
cant trends over time at each temperature. Data analysis was
performed using SAS (SAS Institute Inc, Cary, NC, USA).
Results
Table 1 shows the results obtained in samples separated
immediately after collection from the volunteers, along with the
reference intervals for each analyte. On the whole, the results
obtained for each analyte give good coverage of the reference
interval, with some results being outside of this range.
Table 2 shows the mean percentage change in plasma analyte
concentrations at each time-point, for samples stored at room
temperature (21°C) and chilled (4°C). Figure 1 summarizes
the data by showing the mean percentage change per day for
each analyte under each temperature condition. At 21°C, the
 PLASMA ANALYTE STABILITY AFTER DELAYED SEPARATION OF WHOLE BLOOD 127

Table 1 Assay values in samples separated immediately after collection from 12 healthy volunteers aged 25–60 years (with reference intervals)

Analytea Mean Standard deviation Minimum Maximum Reference intervalb

Albumin (g/l) 42.6 2.5 38.3 46.9 34–47
ALT (U/l) 18.9 5.0 14.0 31.2 14–63
ApoA1 (mg/dl) 156.5 31.9 81.4 209.3 95–228
ApoB (mg/dl) 87.6 21.1 55.2 113.4 51–165
AST (U/l) 20.7 3.8 15.2 26.8 15–41
Cholesterol (mmol/l) 5.1 1.3 2.5 6.7 3.7–7.7
CK (U/l) 114.9 62.5 61.1 276.4 38–397
Creatinine (umol/l) 67.0 10.2 52.9 82.1 35–106
GGT (U/l) 15.1 6.8 10.5 35.0 7–50
HDL (mmol/l) 1.6 0.5 0.7 2.6 0.5–2.1
LDL (mmol/l) 3.0 1.0 1.7 4.5 1.5–4.4
Protein (g/l) 72.2 2.9 65.0 76.4 61–79
Triglyceride (mmol/l) 1.1 0.5 0.6 2.1 0.5–4.7
a ALT, alanine transaminase; apoA1, apolipoprotein A1; apoB, apolipoprotein B; AST, aspartate transaminase; CK, creatine kinase; GGT, γ-glutamyl transferase;
HDL, high density lipoprotein; LDL, low density lipoprotein.

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b Method-specific reference intervals established by Beckman Coulter, except for albumin, cholesterol, HDL, LDL, and triglyceride which were established in-
house from analysis of healthy individuals aged 30–79 years in a case-control study of myocardial infarction (n = 10 074 individuals for albumin and
cholesterol, n = 2912 for HDL, LDL, and triglyceride).

Table 2 Percentage change in analyte concentration over time in samples stored at 21°C and 4°C

% change from immediately separated samples (SEM) P value P value

Analytea Temp 1 day 2 days 3 days 4 days 7 days trend 21°C v 4°C
Albumin 21°C 1.6 (1.0) 1.4 (1.0) 1.7 (0.7) 1.3 (0.5) 3.4 (1.0)
0.0001 0.4
4°C 1.4 (1.1) 2.2 (0.6) 1.3 (0.7) 2.1 (0.7) 3.8 (0.5)
0.0001
ALT 21°C 1.0 (1.8) 2.2 (2.0) 5.3 (1.6) 9.1 (4.3) ORb 0.001
0.0001
4°C –0.5 (1.2) 1.4 (1.7) 0.9 (1.4) 2.2 (1.7) –2.7 (1.3) 0.4
ApoA1 21°C 2.7 (1.1) 0.8 (1.1) 2.1 (1.1) 0.6 (1.0) 1.6 (1.1) 0.7 0.08
4°C 1.8 (1.0) 3.7 (0.8) 1.6 (1.3) 2.2 (0.7) 2.8 (0.6) 0.02
ApoB 21°C 3.8 (1.2) 1.0 (1.6) 2.8 (1.4) 2.1 (1.3) 3.5 (0.9) 0.02 0.6
4°C 1.8 (1.7) 3.3 (1.0) 2.5 (1.0) 2.1 (0.6) 4.3 (0.7) 0.003
AST 21°C 15.2 (3.0) 35.3 (4.2) 40.5 (5.3) 34.4 (7.7) ORb
0.0001
0.0001
4°C 1.5 (1.9) 5.3 (1.0) 7.9 (1.5) 7.9 (1.3) 14.6 (2.6)
0.0001
Cholesterol 21°C 1.5 (1.3) –0.0 (1.4) –0.6 (1.0) –0.8 (0.8) –1.1 (1.3) 0.03 0.0003
4°C 0.7 (1.4) 2.2 (0.8) 0.6 (0.9) 1.2 (1.1) 2.1 (0.6) 0.03
CK 21°C –0.7 (1.2) –8.8 (1.6) –9.9 (1.3) –11.2 (1.4) –15.7 (2.0)
0.0001
0.0001
4°C 3.0 (1.3) 3.5 (0.9) 1.9 (1.3) 2.3 (1.1) 4.0 (1.1) 0.0008
Creatinine 21°C 6.7 (1.2) 18.1 (1.5) 21.1 (1.2) 24.5 (1.7) 42.5 (4.3)
0.0001
0.0001
4°C 0.5 (1.0) 0.8 (1.1) 0.7 (1.0) –0.0 (1.1) 3.8 (1.0) 0.5
GGT 21°C 2.0 (2.7) 7.9 (2.3) 11.3 (3.2) 13.7 (3.3) 10.4 (2.2)
0.0001
0.0001
4°C 0.1 (2.2) 1.4 (2.7) 2.7 (2.0) 0.0 (1.5) 2.0 (1.9) 0.9
HDL 21°C –1.2 (1.4) –3.4 (1.1) –3.9 (1.4) –2.9 (1.0) –3.6 (1.9)
0.0001 0.2
4°C –0.5 (1.8) –0.2 (1.0) –3.3 (0.8) –1.4 (1.0) –3.6 (0.9) 0.005
LDL 21°C 4.8 (1.4) 5.4 (1.6) 6.7 (1.6) 6.2 (1.2) 5.7 (2.1)
0.0001 0.1
4°C 1.6 (1.4) 2.8 (0.7) 2.6 (0.8) 3.6 (0.9) 6.9 (0.7) 0.0002
Protein 21°C 2.5 (1.2) 1.5 (1.4) 1.8 (1.1) 1.2 (0.6) 1.4 (1.1) 0.4 0.2
4°C 2.2 (1.2) 1.9 (0.8) 1.6 (1.1) 1.9 (0.8) 2.8 (0.6) 0.03
Triglyceride 21°C 0.8 (2.2) 2.2 (1.5) 1.4 (1.7) 1.6 (1.8) 0.2 (2.4) 0.6 0.5
4°C 0.4 (1.8) 0.6 (1.5) –3.2 (1.9) –0.7 (1.9) 1.9 (1.1) 0.8
a ALT, alanine transaminase; apoA1, apolipoprotein A1; apoB, apolipoprotein B; AST, aspartate transaminase; CK, creatine kinase; GGT, γ-glutamyl transferase;
HDL, high density lipoprotein; LDL, low density lipoprotein; SEM, standard error of the mean.
b OR, outside range for the analyte.
128 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Figure 1 Percentage change per day (95% CI) for analytes in whole blood samples stored at 21°C or 4°C
for up to 7 days
concentrations of albumin, apoA1, apoB, total cholesterol, HDL,
total protein, and triglycerides differed by less than 4% from the
fresh value up to 7 days after blood collection, while the con-
centration of LDL differed by less than 7%. The mean percent-
age change per day at room temperature was less than 0.5% for
all of those analytes, except for HDL and LDL where it was less
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than 1%. With the exception of total cholesterol, the change
over time did not differ significantly between samples stored at
21°C or 4°C. For total cholesterol, there was a significant difference
(P = 0.0003) between the values in samples kept at the different
temperatures, but it was small and did not become apparent
until 7 days.
 PLASMA ANALYTE STABILITY AFTER DELAYED SEPARATION OF WHOLE BLOOD
By contrast, concentrations of ALT, CK, creatinine, and GGT
changed more markedly at 21°C: for example, creatinine
increased by more than 20% in whole blood after 3 days. Under
chilled conditions at 4°C, however, these analytes were more
stable, and changed by less than 4% in whole blood after 7 days
(P
0.0001 for 21°C versus 4°C). The mean percentage change
per day for these analytes under chilled conditions was less than
0.7%. Although a significant trend (P = 0.0008) towards an
increase in CK values was observed over time in samples kept
at 4°C, the change was small. Of the analytes measured, only
AST was found to change substantially under both temperature
conditions. The concentration of AST increased by more than
7% after 3 days at 4°C, and by more than 15% after just one
day at 21°C. The percentage changes in ALT and AST appeared
to be somewhat greater in the samples with lower baseline
levels compared with higher baseline levels, but more indi-
viduals with a wider range of baseline values would need to be
studied to assess this reliably.
Discussion
The stability of a wide range of plasma analytes in whole blood
samples stored for several days is much better than had perhaps
been widely believed. The present study demonstrates that
albumin, apoA1 and apoB, total cholesterol, HDL, LDL, protein,
and triglycerides can be measured reliably in whole blood
samples kept at room temperature for at least a week before
plasma separation. Alanine transaminase, CK, creatinine, and
GGT exhibited greater change at room temperature, hence
reliable quantification of these analytes would require whole
blood samples to be kept chilled before separation. However,
since the mean concentrations of these analytes were found to
change by less than 4% during up to 7 days in chilled blood,
such samples do not require rapid transfer to a central lab-
oratory for separation. The most unstable analyte was found to
be AST, with reliable quantification of this analyte requiring
blood samples to be separated immediately or, if kept chilled,
within 24 to 48 hours.
Only three previous studies have investigated the stability of
general clinical chemistry analytes in blood kept unseparated
beyond 24 hours. Ono et al. drew blood from 10 volunteers into
plain serum tubes and left aliquots of whole blood to stand at
4°C, 23°C, or 30°C for up to 48 hours.4 They found no signifi-
cant change in albumin, total cholesterol, triglyceride, or total
protein at 4°C or 23°C, which is in agreement with the present
study. However, they also found GGT and creatinine to be stable
at these temperatures, whereas we found them to change by
8% and 18% respectively after 48 hours at 21°C. Whilst Ono
et al. found little change in ALT and AST at 4°C, the concentra-
tions increased significantly after 8 hours at 23°C. We found
ALT to change by only 2% up to 48 hours at 4°C and 21°C, but
AST changed by 5% at 4°C and by 35% at 21°C after 48 hours.
These discrepancies may reflect differences in the analytical
methods used in the present study compared with those used
20 years ago by Ono et al., and the use of serum rather than
plasma samples.
In another study, Hankinson et al.5 investigated the stability
of total cholesterol, HDL, apoA1, and apoB in whole blood
samples taken from 12 individuals and stored at room tem-
perature (21°C) in ambient light for up to 72 hours, or placed in
129
a Styrofoam mailer with a frozen gel pack (which maintained
a temperature of 4°C for 20 hours) for up to 48 hours. The study
design was similar to that of the present study, with whole blood
samples stored under each temperature condition up to the appro-
priate time-point, then centrifuged, the plasma aliquoted and
frozen at –80°C. Samples from all time-points were analysed in
one analytical run. The concentrations of all of the lipids were
found to change non-significantly in chilled blood. However, at
room temperature, although total cholesterol and apoA1 changed
only non-significantly, HDL and apoB increased by 3.0% and
5.2% per day respectively. By contrast, in the present study,
HDL and apoB changed by –0.6% and +0.4% per day respectively
at room temperature. The discrepancies between the results of
the two studies may also reflect differences in the analytical
methods. Hankinson et al. measured HDL by precipitation of very
low density lipoprotein (VLDL) and LDL with dextran sulphate
and magnesium chloride, apoA1 was measured in the HDL and
HDL3 fractions by radial immunodiffusion and apoB measured
in whole plasma by radial immunodiffusion. By contrast, in the
present study, the analytes were measured directly in plasma by
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automated methods optimized to deal with potential inter-
ference from colour due to haemolysis, which becomes more of
a problem as the delay to plasma separation increases.7 In
addition, the blood samples stored at room temperature in the
study by Hankinson et al. were exposed to ambient light, which
might have affected stability of HDL and apoB, whereas samples
in the present study were stored in the dark.
Finally, Heins et al. investigated the stability of various analytes
in whole blood samples taken from 20 apparently healthy
individuals into plain serum tubes and then stored chilled (9°C)
or at room temperature (23–27°C) in the dark for 7 days.6 An
analyte was described as unstable if the change in concentration
was significantly greater than the maximum allowable inaccuracy
according to the Guidelines of the German Federal Medical
Council: 6% for creatinine, cholesterol, HDL, and LDL; 7% for
AST, ALT, and GGT; and 8% for CK. These investigators reported
ALT, AST, and cholesterol to be stable for 7 days at 9°C, and for
3 days at room temperature. By contrast, however, we found
that the mean concentration of AST changed by more than 14%
after 7 days under chilled conditions and by over 40% after
3 days at room temperature. Other studies have also found a
substantial increase in AST, due to haemolysis and a 40-fold
higher activity of AST in erythrocytes compared with serum.8,9
Heins et al. reported HDL, LDL, CK, and GGT to be stable for
7 days at 9°C, but not at 23–27°C. We also found CK to change
by less than 8%, and GGT to change by less than 7%, after
7 days under chilled conditions. Moreover, in our study, HDL
and LDL changed by less than 7% after 7 days not only under
chilled conditions, but also at room temperature. Heins et al.
found that creatinine concentrations increased by around 20%
at room temperature over 3 days (which agrees with the present
study) but decreased by around 8% over the same period at 9°C
(whereas we found less than a 4% change over 7 days under
chilled conditions). Discrepancies between the results of Heins
et al. and the present study might be explained by differences in
analytical methods, by the ways of dealing with interference
from haemolysis, by differences in temperature conditions, or
by the use of serum rather than plasma samples. Furthermore,
Heins et al. performed biochemical measurements on the
samples immediately after centrifugation at each time-point,
130 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
rather than freezing the samples and analysing them all in
the same run, as in the present study, so that day-to-day assay
variability may have affected results.
Many analytes considered in the present study did exhibit a
slight increase in concentration over time, which agrees with a
previous study.7 This is contrary to what one might expect to
observe from analyte degradation, and seems likely to be due to
leakage of water from the plasma into the red cells (following
failure of the sodium/potassium pump to maintain osmotic
balance) resulting in swelling of red cells, increase in the
haematocrit, decrease in the plasma volume and, therefore,
increased concentration of plasma analytes. It has also been
reported that certain analytes, particularly AST, have a much
higher activity in red blood cells than plasma, causing an in-
creased concentration in haemolysed plasma.8,9 Furthermore, it
has been suggested that the increase in creatinine concentration
during storage is due to non-specific formation of pseudo-
creatinines.6 Recording the length of time from collection to
separation of each sample might allow appropriate adjustment
to be made for the slight increase in concentration of these
analytes over time. The degree of change in analyte concentra-
tions may differ slightly in a real situation compared with a
laboratory setting, as is suggested by some of the results from
Hankinson et al.5 In a study involving mailed blood samples
from around 20 000 individuals, cholesterol concentrations in
samples that had spent 4 days in the post were an average of
about 7% higher than in those that had spent one day in the
post, but there was less than a 2% difference in apoA1 levels
(Clark S, Youngman LD, Parish S, Palmer A, Peto R, Collins R.
Total cholesterol, apolipoproteins B and A1, and non-fatal myo-
cardial infarction: 19 594 male and female cases and controls of
KEY MESSAGES
• Simple blood collection methods could help make large blood-based epidemiological studies feasible.
• The concentrations of a wide range of analytes (including lipids) may be measured reliably in whole blood stored
at room temperature for up to 7 days.
• Collection of whole blood samples by mail is a simple and cost-effective way to facilitate the inclusion of blood
assays in large-scale epidemiological studies.
References
1 Young DS, Bermes EW. Specimen collection and processing: sources
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2 O’Connell T, Thornton L, O’Flanagan D et al. Oral fluid collection by
post for viral antibody testing. Int J Epidemiol 2001;30:298–301.
3 Perneger TV, Etter J-F. Commentary: Extending the boundaries of
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4 Ono T, Kitaguchi K, Takehara M, Shiiba M, Hayami K. Serum-
constituents analyses: effect of duration and temperature of storage of
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‘room temperature’ in the present study was defined as 21°C,
which may not be realistic for studies in hotter climates (and
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ducted). However, since many analytes were found to change
by only a few per cent over at least 7 days at 21°C, it might be
supposed that any change at higher temperatures may remain
in this range for at least 3 to 4 days, which might still be a
feasible time-frame within which to transport whole blood
samples to a central facility.
In conclusion, we have shown that the concentrations of
many analytes change by only a few per cent in whole blood
stored at room temperature for up to 7 days, and may therefore
be measured reliably in mailed blood samples. These results
are relevant for planning blood-based epidemiological studies.
Depending upon the analytes to be measured, blood collection
methods could be greatly simplified and, hence, the costs vastly
reduced, enabling blood collection to be included in studies
where it would not otherwise be considered feasible.
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Acknowledgements
This work was supported by the Medical Research Council, the
British Heart Foundation and Cancer Research UK. We grate-
fully acknowledge Mary Bradley, Tatyana Chavagnon, Buki
Chukwurah, Kathy Emmens, Joanne Gordon, Joy Hill, Meng
Jie Ji, Karen Kourellias, Stuart Norris, Leon Peto, Martin Radley,
Janet Taylor, Jane Wintour, and Marie Yeung of the Clinical
Trial Service Unit and Epidemiological Studies Unit (CTSU)
laboratories. Dr Robert Clarke provided helpful comments on
the manuscript.
5 Hankinson SE, London SJ, Chute CG et al. Effect of transport
conditions on the stability of biochemical markers in blood. Clin Chem
1989;35:2313–16.
6 Heins M, Heil W, Withold W. Storage of serum or whole blood
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Clin Chem Clin Biochem 1995;33:231–38.
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