Test ID: ASB
Arsenic, Blood
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Detection of acute or very recent arsenic exposure
Monitoring the effectiveness of therapy
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Arsenic (As)
Specimen Type Describes the specimen type needed for testing
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.
Container/Tube: Royal-blue top (EDTA) Monoject trace element blood collection tube, product #8881-307022 (Supply T183)
Specimen Volume: Full tube
Collection Instructions:
1. Send specimen in original collection tube.
2. See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.
Additional Information: High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
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.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross OK |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross reject |
| Other | Green top (heparin) tube |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Whole blood | Refrigerated (preferred) | 21 days |
| Ambient | 21 days | |
| Frozen | 21 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Arsenic (As) exists in a number of toxic and nontoxic forms. The toxic forms are the inorganic species As(+5), also denoted as As(V), the more toxic As(+3), also known as As(III), and their partially detoxified metabolites, monomethylarsine (MMA) and dimethylarsine (DMA). Detoxification occurs in the liver as As(+3) is oxidized to As(+5) and then methylated to MMA and DMA. As a result of these detoxification steps, As(+3) and As(+5) are found in the urine shortly after ingestion, whereas MMA and DMA are the species that predominate more than 24 hours after ingestion.
Blood concentrations of arsenic are elevated for a short time after exposure, after which arsenic rapidly disappears into tissues because if its affinity for tissue proteins. The body treats arsenic like phosphate, incorporating it wherever phosphate would be incorporated. Arsenic "disappears" into the normal body pool of phosphate and is excreted at the same rate as phosphate (excretion half-life of 12 days). The half-life of inorganic arsenic in blood is 4 to 6 hours, and the half-life of the methylated metabolites is 20 to 30 hours. Abnormal blood arsenic concentrations (>12 ng/mL) indicate significant exposure, but will only be detected immediately after exposure. Arsenic is not likely to be detected in blood specimens drawn more than 2 days after exposure because it has become integrated into nonvascular tissues. Consequently, blood is not a good specimen to screen for arsenic, although periodic blood levels can be determined to follow the effectiveness of therapy. Urine is the preferred specimen for assessment of arsenic exposure.
A wide range of signs and symptoms may be seen in acute arsenic poisoning including headache, nausea, vomiting, diarrhea, abdominal pain, hypotension, fever, hemolysis, seizures, and mental status changes. Symptoms of chronic poisoning, also called arseniasis, are mostly insidious and nonspecific. The gastrointestinal tract, skin, and central nervous system are usually involved. Nausea, epigastric pain, colic (abdominal pain), diarrhea, and paresthesias of the hands and feet can occur.
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.
0-12 ng/mL
Reference values apply to all ages.
Interpretation Provides information to assist in interpretation of the test results
Abnormal blood arsenic concentrations (>12 ng/mL) indicate significant exposure.
Absorbed arsenic is rapidly distributed into tissue storage sites with a blood half-life of <6 hours. Unless a blood specimen is drawn within 2 days of exposure, arsenic is not likely to be detected in a blood specimen.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Measurement of urine arsenic is the preferred method of screening for arsenic exposure. Blood is not a good specimen to screen for arsenic.
This test is not useful for evaluation of chronic arsenic exposure.
High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen must not be collected for 96 hours.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Hall M, Chen Y, Ahsan H, et al: Blood arsenic as a biomarker of arsenic exposure: results from a prospective study. Toxicology 2006;225:225–233
Method Description Describes how the test is performed and provides a method-specific reference
This assay is performed on a inductively coupled plasma-mass spectrometer. Calibrating standards and blanks are diluted with an aqueous acidic diluent containing internal standards. Quality control specimens and patient samples are diluted in an identical manner. In turn, all diluted blanks, calibrating standards, quality control specimens, and patient specimens are aspirated into a pneumatic nebulizer and the resulting aerosol directed to the hot plasma discharge by a flow of argon. In the annular plasma the aerosol is vaporized, atomized, then ionized. The ionized gases plus neutral species formed in the annular plasma space are aspirated from the plasma through an orifice into a quadrupole mass spectrometer. The mass range from 1 amu to 263 amu is rapidly scanned multiple times and ion counts tabulated for each mass of interest. Instrument response is defined by the linear relationship of analyte concentrations vs. ion count ratio (analyte ion count/internal standard ion count). Analyte concentrations are derived by reading the ion count ratio for each mass of interest and determining the concentration from the response line. (Nixon DE, Moyer TP: Routine clinical determination of lead, arsenic, cadmium, and thallium in urine and whole blood by inductively coupled plasma mass spectrometry. Spectrochimica Acta Part B-Atomic Spectroscopy 1996;51:13-25)
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 Friday; 8 a.m. - 2 p.m. Saturday; 8 a.m. - 3 p.m. 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.
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.
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.
82175
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 |
|---|---|---|
| 32190 | Arsenic, B | In Process |
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