Sample Collection Practices That can Lead to Elevated or Lower Blood Drug Concentrations: Grand Rounds 2022


When: This event originally occurred on February 18th, 2022.

Presenter: Dr. Charles Catanese, Forensic Pathologist with Ulster County, NY

Presenter: Dr. Laura Labay, Director of Toxicological Services, NMS Labs, Horsham, PA


The preanalytical phase is the phase where the laboratory has no direct control over the testing process. It includes variables such as quality of sample collection, labeling of collection containers, and storage and shipping protocols. Any preanalytical steps must be performed with the mindset that any error cannot be remedied by the laboratory and may adversely affect the interpretation of toxicology results. In the age of accreditation and standardized protocols, postmortem laboratories have become adept at handling, preparing, and analyzing less than ideal specimens. An important concept to remember is that a toxicology result only represents what was there at the time of testing, not what was necessarily there at the time of death. Any strategies that can be employed in the autopsy suite to mitigate preanalytical variables should be deployed with each case. The focus of this Grand Round presentation is to demonstrate best practices for sample collection for blood and vitreous fluid and juxtapose these practices with techniques that can cause alteration of drug concentrations within the collected samples.


Detailed Learning Objectives:


1)    Understand how sample collection practices can affect toxicology results and case interpretation.  

2)    Identify strategies to prevent sample contamination during the autopsy process and maintain case chain-of-custody. 

3)    Explain how sample storage and transport conditions can affect analyte stability and case interpretation.


*Funding for this training was made possible by a cooperative agreement between the National Network of Public Health Institutes and the Centers for Disease Control and Prevention [6 NU38OT000303-03-02]. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Centers for Disease Control and Prevention nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.


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