Methemoglobin and Sulfhemoglobin, Blood
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Diagnosing methemoglobinemia and sulfhemoglobinemia
Identifying cyanosis due to other causes, such as congenital heart disease
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
|Test ID||Reporting Name||Available Separately||Always Performed|
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Methemoglobin and Sulfhemoglobin, B
Specimen Type Describes the specimen type needed for testing
Whole Blood EDTA
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Specimen must arrive within 48 hours of draw.
Container/Tube: Lavender top (EDTA)
Specimen Volume: Full tube
Additional Information: Patient's age is required.
Forms: If not ordering electronically, please submit a Hematopathology/Molecular Oncology Request Form (Supply T241) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Mild OK; Gross reject
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
|Whole Blood EDTA||Refrigerated||72 hours|
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
When iron in hemoglobin is oxidized from the normal divalent state to a trivalent state, the resulting brownish pigment is methemoglobin. Methemoglobin cannot combine reversibly with oxygen and is associated with cyanosis.
Methemoglobinemia, with or without sulfhemoglobinemia, is most commonly encountered as a result of administration of medications such as phenacetin, phenazopyridine, sulfonamides, local anesthetics, dapsone, or following ingestion of nitrites or nitrates. Congenital methemoglobinemias are rare. They are either due to:
-Deficiency of methemoglobin reductase (also called cytochrome B5 reductase or diaphorase) in erythrocytes, an autosomal recessive disorder.
-One of several intrinsic structural disorders of hemoglobin, called methemoglobin-M, all of which are inherited in the autosomal dominant mode.
Methemoglobinemia responds to treatment with methylene blue or ascorbic acid.
Sulfhemoglobin cannot combine with oxygen. Sulfhemoglobinemia is associated with cyanosis and often accompanies drug-induced methemoglobinemia. Sulfhemoglobinemia can be due to exposure to trinitrotoluene or zinc ethylene bisdithiocarbamate (a fungicide), or by ingestion of therapeutic doses of flutamide.
In contrast to methemoglobinemia, sulfhemoglobinemia persists until the erythrocytes containing it are destroyed. Therefore, blood level of sulfhemoglobin declines gradually over a period of weeks.
Patients with sulfhemoglobinemia often also have methemoglobinemia. There is no specific treatment for sulfhemoglobinemia. Therapy is directed at reversing the methemoglobinemia, if present.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
0-11 months: not established
> or =1 year: 0.0-1.5% of total hemoglobin
0-11 months: not established
> or =1 year: 0.0-0.4% of total hemoglobin
In congenital methemoglobinemia, the methemoglobinemia concentration in blood is about 15% to 20% of total hemoglobin. Such patients are mildly cyanotic and asymptomatic.
In acquired (toxic) methemoglobinemia, the concentration may be much higher. Symptoms may be severe when methemoglobin is >40% of hemoglobin. Very high concentrations (>70%) may be fatal.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Methemoglobin is unstable and is reduced to hemoglobin at a rate of about 40% per day at 0 to 4 degrees C.
A normal methemoglobin value obtained with stored or shipped specimens does not exclude prior mild methemoglobinemia. However, significant methemoglobinemia will still be demonstrable.
Sulfhemoglobin is stable and does not change in stored or shipped specimens.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Beutler E: Methemoglobinemia and other causes of cyanosis. In Hematology. Sixth edition. Edited by WJ Williams, E Beutler, AJ Erslev, MA Lichtman. New York, McGraw-Hill Book Company, 2001, pp 611-614
Method Description Describes how the test is performed and provides a method-specific reference
The normal absorption spectrum of oxyhemoglobin has very little optical density above 600 nm. The absorption spectrum of methemoglobin exhibits a small, characteristic peak at 630 nm. This peak is abolished as methemoglobin is converted to cyanmethemoglobin upon addition of potassium cyanide, and the drop in optical density is proportional to methemoglobin concentration.
The normal absorption spectrum of oxyhemoglobin has very little optical density above 600 nm. However, if certain poorly defined hemoglobin denaturation products are present in a hemolysate, there is a broad elevation of the absorption curve in the range of 600 nm to 620 nm. This "sulfhemoglobin" plateau is not affected by treatment with cyanide. Sulfhemoglobin is not available, nor can it be prepared, in a pure form for preparation of a sulfhemoglobin standard. In calculating sulfhemoglobin concentration, the factor for sulfhemoglobin quantitation is based on studies of Carrico, et al (1978).(Evelyn KA, Malloy HT: Microdetermination of oxyhemoglobin, methemoglobin, and sulfhemoglobin in a single sample of blood. J Biol Chem 1938;126:655-662; Carrico RJ, Peisach J, Alben JO: The preparation and some physical properties of sulfhemoglobin. J Analyt Biochem 1978;253:2386-2391; Fairbanks VF, Klee GG: Biochemical aspects of hematology. In Teitz Textbook of Clinical Chemistry. Edited by CA Burtis, ER Ashwood, WB Saunders Company, 1999, pp 1676-1678)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Saturday; Continuously
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Same day/1 day
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
|Result ID||Reporting Name||LOINC Code|