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Dec 14, 2023

Blood Collection Tube Shortages Continue

A laboratory technician places human blood samples on an automated testing line.

A laboratory technician places human blood samples on an automated testing line. This laboratory, ... [+] which operates a fully automated system complete with advanced robotics, can test more than 50,000 blood samples a day. The lab is considered one of the most modern of its kind in the western world. (Photo by David Silverman/Getty Images)

Covid has again brought attention to supply chain issues, this time regarding shortages of blood collection tubes. It's surprising how something so seemingly mundane can have an outsized impact—and how difficult it is to get answers about from both industry and the FDA.

In the US, the FDA first listed a shortage of sodium citrate (the light blue top) tubes on their device shortages. They describe the problem euphemistically as being due to an "increase in demand and recent vendor supply challenges." These light blue top tubes are used to measure coagulation and were used more frequently as coagulation abnormalities have been a significant problem with Covid.

Now, the FDA says the shortages are more widespread, affecting all types of tubes. Vacuum tubes, aka "vacutainers," are made of either plastic or glass. The color of the stopper indicates what kind of additive the vacutainer contains.

Becton-Dickinson is a leader in this market. A BD spokesperson said that during Covid, they have seen "the most unpredictable demand that BD has experienced in our company's history." They added, "Worldwide, BD produced nearly a half a billion additional blood tubes in 2021 versus 2020…Like every business across every industry around the world, BD is experiencing limited availability of and access to raw materials, shipping and transportation delays, and labor shortages, which hinders our ability to ramp production."

Christine Nielsen, CEO of the Canadian Society for Medical Laboratory Science, added a broader perspective. She said the problem is not limited to the tubes but includes basic supplies like buffered saline. Nelson said, "It's also a challenge because we've moved to just in time inventory across all sectors, including labs…They outdate just like food is no longer fresh. It's no longer reliable, and you can't use it. So we can't stockpile either."

Nielsen also noted that many lab manufacturers had focused their attention on the rapid point of care testing with Covid, a marked shift for the businesses.

One of the major responses in Canada has been an educational campaign, "Using Labs Wisely," part of a broader "Choosing Wisely" effort. They have many sound suggestions, including:

If you do enough tests, something will come back abnormal and lead to needless further investigation. "Abnormal" results are found in at least 5% of people—though it may be their norm.

Instead, just give Vitamin D supplements.

Consider if and how a test result will change patient management, which is often overlooked in routine screening labs.

For inpatients, Using Labs Wisely has two particularly useful suggestions:

Shortages in Canada are severe enough that there has been talk of needing to limit outpatient testing if it worsens. They have the added problem that the US is no longer allowing exports of the tubes.

Nielsen echoed a concern often raised by Rodney Rohde, professor of clinical laboratory science at Texas State University, the growing shortage of medical lab professionals.

Both spoke about severe staffing shortages of up to 26%, from Covid itself and burnout. In both, there is also lack of internships.

According to news reports, the shortages are expected to last for months.

This issue of vacutainer shortages is but one example of the problems of just-in-time inventories, short staffing as much as possible, and reliance on overseas production. We also need to do a better job educating the public and physicians about such shortages; it seems Canada has done a better job on this topic.