K₂EDTA Versus K₃EDTA Stability in Yemeni Laboratories: Toward Climate-Adapted Protocols for Resource-Limited Settings

Naif Taleb Ali ¹^,²

Keywords: Preanalytical variability, EDTA anticoagulants, Sysmex KX-21N, resource-limited settings, Yemen, tropical hematology, Yemeni laboratories

DOI: 10.63475/yjm.v4i2.0150

DOI URL: https://doi.org/10.63475/yjm.v4i2.0150

Publish Date: 22-09-2025

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Pages: 379 - 385

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Author Affiliation:

1 Professor, Department of Laboratory Sciences, Radfan University College, University of Lahej, Al-Hoata, Yemen
2 Professor, Department of Health Sciences, Faculty of Medicine, University of Sciences and Technology, Aden, Yemen

Abstract

Background: Preanalytical variability due to anticoagulant choice remains inadequately characterized in resource-limited tropical settings like Yemen, where environmental stressors exacerbate challenges. This study aimed to compare the stability and cost-effectiveness of K₂EDTA and K₃EDTA anticoagulants for complete blood count testing under simulated Yemeni conditions.

Methods: Prospective study of 100 healthy adult male volunteers in Ad’Dla Governorate, Yemen (January–March 2025). Paired samples in K₂EDTA/K₃EDTA tubes were analyzed at baseline (T0) and after 6-hour storage at 22 ± 2°C (T6). Statistical analysis included Bonferroni-corrected repeated-measures ANOVA and paired t-tests.

Results: Fresh samples showed high inter-anticoagulant concordance (ICC > 0.90). After 6-hour storage, K₂EDTA exhibited significant Mean Corpuscular Volume (MCV) reduction (Δ = −2.33 fL, p < 0.001; Cohen’s d = 0.42), while K₃EDTA showed greater Red Blood Cell (RBC) instability (Δ = −0.16 × 10¹²/L, p = 0.008). An observed bidirectional Red Cell Distribution Width – Standard Deviation (RDW-SD) pattern emerged: K₂EDTA increased values (+1.71%) while K₃EDTA decreased them (−2.20%, both p < 0.01). K₃EDTA offered 4.7% direct cost savings per test but incurred higher slide-review costs due to 8% platelet clumping.

Conclusions: K₂EDTA demonstrates superior stability for delayed processing (> 2 hours), while K₃EDTA is preferable for immediate analysis. These findings provide preliminary guidance for hematology testing in Yemeni laboratories and similar tropical settings, pending validation in diverse populations and extreme conditions.

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