Test ID: CYAN
Cyanide, 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
Monitoring possible exposure to cyanide
Establishing cause of death in cyanide exposure
Not useful for monitoring nitroprusside.
Method Name A short description of the method used to perform the test
Colorimetric
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
Laetrile
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: Lavender top (EDTA)
Specimen Volume: 3 mL
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 OK |
| Other | NA |
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 EDTA | Ambient (preferred) | 14 days |
| Frozen | 14 days | |
| Refrigerated | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Cyanide (hydrocyanic acid, prussic acid) blocks cellular respiration by binding to and inactivating hemoglobin and enzymes such as cytochrome oxidase having prosthetic groups containing ferric iron (Fe+++). Cyanide is metabolized rapidly by the liver where it is converted to thiocyanate.
Therapy of hypertensive crisis with nitroprusside (Nipride) results in elevated cyanide blood concentrations, because the cyano function is transferred from nitroprusside to hemoglobin in the red cell.
Symptoms of cyanide poisoning include giddiness, hyperpnea, headaches, palpitation, cyanosis, and unconsciousness. Asphyxial convulsions may precede death; death normally ensues within a few minutes to 3 hours, depending upon the dose. As long as the heart continues to beat, there is a chance of saving the patient because effective antidotes are available; treatment with sodium nitrite and sodium thiosulfate can be effective.
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.
Normal: <0.2 mcg/mL
Toxic concentration: > or =2.0 mcg/mL
Interpretation Provides information to assist in interpretation of the test results
Blood concentrations in the average population are as high as 0.2 mcg/mL, mostly derived from vegetables such as brussel sprouts.
Significant contact with cyanide can produce blood concentrations up to 2.0 mcg/mL without side effects.
At concentrations of 2.0 mcg/mL to 4.0 mcg/mL, giddiness, headaches, and hyperpnea are evident.
Concentrations >5.0 mcg/mL are potentially lethal.
Normal concentration: <0.2 mcg/mL
Toxic concentration: > or =2.0 mcg/mL
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Concentrations as high as 8.0 mcg/mL without symptoms of cyanide toxicity are commonly associated with nitroprusside therapy; one should monitor thiocyanate to determine the potential for intoxication during nitroprusside therapy for hypertensive crisis.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Medical Toxicology, 3rd edition, RC Dart editor. 2004 pp 1162, 1800
Method Description Describes how the test is performed and provides a method-specific reference
Hydrogen cyanide gas is released from blood by the addition of a strong acid in a sealed device (Conway). In the Conway cell, a separate chamber, containing a sodium hydroxide solution absorbs the released hydrogen cyanide gas. An aliquot from the sodium hydroxide absorption medium is then allowed to react in strong acid with pyridine, barbituric acid, and chloramine-T for subsequent development of a red color. The absorbance of the solution is used to quantitate cyanide ion. (Ames MM, Moyer TP, Kovach JS, et al: Pharmacology of amygdalin [laetrile] in cancer patients. Cancer Chemother Pharmacol 1981;6:51-57)
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, Wednesday, Friday; 5 p.m.
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.
82600
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 |
|---|---|---|
| 8691 | Cyanide, B | 5634-1 |
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