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Sodium Citrate as a Preservative in Forensic Medicine
What is Sodium Citrate?
Sodium citrate (Na₃C₆H₅O₇) is a sodium salt of citric acid. In forensic and laboratory contexts it functions primarily as an anticoagulant - it works by chelating (binding) ionized calcium (Ca²⁺) from blood, which is required at multiple steps of the coagulation cascade. Without free calcium, blood cannot clot. It also has mild preservative properties by inhibiting some enzymatic degradation.
Role in Forensic Specimen Preservation
1. Blood Grouping
For blood preserved for ABO grouping (not toxicological analysis), the standard preservative is:
5% w/v sodium citrate in water + 0.25% v/v formalin (equal volume to blood collected; approximately 2-3 mL blood is sufficient)
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The sodium citrate acts as the anticoagulant to keep blood liquid
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The formalin component (0.25%) fixes and preserves the red cell antigens for grouping
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This combination is used when the purpose is identity/blood group determination, not poison analysis
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Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology, p. 140
2. Specific Poisoning Cases - When Sodium Citrate Replaces Potassium Oxalate
In most poisoning cases, the standard preservative for liquid blood (10 mL) is:
- 30 mg potassium oxalate (anticoagulant) + 10 mg/mL sodium fluoride (enzyme inhibitor, prevents glycolysis)
However, sodium citrate (30 mg per 10 mL blood) is used as a substitute for potassium oxalate in specific poisoning scenarios where oxalate would interfere with analysis:
| Suspected Poison | Why Sodium Citrate Instead of Potassium Oxalate |
|---|
| Oxalic acid poisoning | Adding more oxalate (from potassium oxalate) would contaminate the sample and interfere with detection of the very poison being tested |
| Ethylene glycol poisoning | Ethylene glycol is metabolized to oxalic acid in the body; adding exogenous oxalate interferes with accurate analysis |
So the rule is:
In poisoning by oxalic acid and ethylene glycol - use 30 mg sodium citrate (not potassium oxalate) per 10 mL blood as the anticoagulant/preservative.
- The Essentials of Forensic Medicine and Toxicology, 36th Edition (2026)
- Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology
3. Why Not Use EDTA or Heparin?
Both EDTA and heparin are NOT used as anticoagulants in forensic blood samples because:
- They interfere with the detection of methanol (a commonly analyzed substance in suspected poisoning and drink-driving cases)
- EDTA chelates metals and can affect heavy metal analysis
- Heparin can interfere with DNA extraction procedures
Sodium citrate does not carry these interferences, making it preferable in specific contexts.
- Parikh's Textbook of Medical Jurisprudence, Forensic Medicine and Toxicology
Summary Table: Preservatives Used for Forensic Blood Specimens
| Purpose | Preservative Used |
|---|
| Routine blood grouping / identity | 5% sodium citrate + 0.25% formalin |
| General toxicology / alcohol analysis | Potassium oxalate (30 mg) + sodium fluoride (10 mg/mL) |
| Oxalic acid poisoning | Sodium citrate (30 mg/10 mL) + sodium fluoride |
| Ethylene glycol poisoning | Sodium citrate (30 mg/10 mL) + sodium fluoride |
| Fluoride poisoning | Sodium nitrite (10 g) replaces sodium fluoride |
| Carbon monoxide poisoning | Liquid paraffin layer (1-2 cm) over sample, airtight cap |
| Cocaine analysis | Sodium fluoride; avoid plastic containers |
Other Forensic Preservatives for Context
| Specimen | Standard Preservative |
|---|
| Viscera (stomach, liver, kidney, spleen) | Saturated saline OR rectified spirit |
| Urine | Sodium fluoride (100 mg/10 mL), or thymol, or saturated NaCl |
| Blood (general toxicology) | Potassium oxalate + sodium fluoride |
| Blood (alcohol/CO/CN) | Sodium fluoride; airtight cap for CO/CN |
| Vitreous humor (for alcohol) | Sodium fluoride |
| CSF (for alcohol) | Sodium fluoride |
Note: Formaldehyde/formalin must NOT be used to preserve viscera for toxicological analysis - it makes extraction of non-volatile organic compounds extremely difficult.
No preservative is needed if: viscera can be analyzed within 24 hours, samples can be refrigerated/kept on ice, or specimens are bone, hair, or nails.
Mechanism of Action (Anticoagulant Effect)
Sodium citrate works by forming a soluble, non-ionized complex with calcium ions:
Na₃-citrate + Ca²⁺ → Ca-citrate complex (non-ionized) + 3 Na⁺
This reversibly removes free Ca²⁺ from plasma, blocking the coagulation cascade at multiple points (factors IV, VII, IX, X, thrombin, fibrin polymerization all require calcium). Because it is reversible (unlike oxalate which precipitates calcium), recalcification of citrated plasma is possible - which is why sodium citrate is the anticoagulant of choice in coagulation studies (PT, APTT) at a concentration of 3.2% (0.109 M) in a 9:1 blood-to-anticoagulant ratio.
- Tietz Textbook of Laboratory Medicine, 7th Edition
- Henry's Clinical Diagnosis and Management by Laboratory Methods