Recommendation on sampling, transport, and storage for the determination of the concentration of ionized calcium in whole blood, plasma, and serum. IFC Scientific Division, Working Group on Ion-Selective Electrodes (WGSE).

The substance concentration of ionized calcium (cCa 2+) in blood, plasma, or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution. pH changes in whole blood can be minimized by anaerobic sampling to avoid loss of CO 2, by measuring as soon as possible, or by storing the sample in iced water to avoid lactic acid formation. cCa 2+ and pH should be determined simultaneously. Plasma or serum: If centrifuged in a closed tube and measured immediately, the pH of the sample will be close to the original value. If there has been a delay between centrifugation and measurement, causing substantial loss of CO 2, equilibration of the sample with a gas mixture corresponding to pCO 2 = 5.3 kPa prior to the measurement is recommended. Conversion of the measured values to cCa 2+ (7.4) is only valid if the pH is in the range 7.2-7.6. Ca 2+ binding by heparin can be minimized by using either of the following: 1) a final concentration of sodium or lithium heparinate of 15 IU/mL blood or less; or 2) calcium-titrated heparin with a final concentration of less than 50 IU/mL blood. Dilution effect can be avoided by use of dry heparin in capillaries or syringes.(ABSTRACT TRUNCATED AT 250 WORDS)