June 2018: Changes to Cyanide, Blood (CYANID) Testing

Special Communication

Changes to Cyanide, Blood (CYANID) Testing

Effective August 15, 2018.

Specimen Requirements

Volume:
4 mL, whole blood

Minimum Volume:
3 mL, whole blood

Specimen Container (Primary):
Green Sodium Heparin Tube

Specimen Container (Primary):
Green Lithium Heparin Tube

Alternative Container:
Lavender BD Hemogard™ K2EDTA Tube

Serum or plasma specimens are unacceptable.

Transport:
Ambient (room) temperature

Patient Preparation:
Timing of specimen collection is dependent on the time of exposure; test upon presentation to hospital.

Stability

Ambient
72 hours, if tightly-capped

Refrigerated
Unacceptable

Frozen
Unacceptable

Methodology

Quantitative Colorimetric

Reference Range

Non-smoker: < 20 μg/dL

Smoker: < 40 μg/dL

Days Performed/Reported

Performed
Sunday, Wednesday, and Friday

Turnaround Time
2–6 days

Special Information

Timing of specimen collection is dependent on the time of exposure; test upon presentation to hospital.

This test is New York DOH approved.

Frozen or refrigerated specimens will be rejected.

Clotted or hemolyzed specimens will be rejected.

Serum or plasma specimens are unacceptable.

Clinical Information

This test is used to monitor cyanide exposure. Cyanide poisoning can cause hypoxia, dizziness, weakness, and mental and motor impairment.

Elevated cyanide concentrations rarely indicate toxicity for patients on nitroprusside therapy. Thiocyanate should be monitored in patients on nitroprusside therapy for potential toxicity. Toxicity may occur with long-term nitroprusside use (longer than 7–14 days with normal renal function, and 3-6 days with renal impairment at greater than 2 μg/kg/min infusion rates).

Thiocyanate levels may be monitored on an every-other-day basis to assess potential thiocyanate toxicity and to indicate possible adjustments in dosage.

Any additional information will be included in a future Technical Update.  If you have any questions about these changes, please contact Client Services for assistance.