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Beaumont Laboratory

Carboxyhemoglobin in Blood (HbCO)

Carbon monoxide , EPIC: LAB5343, SOFT: HGBCO

Specimen Collection Criteria

Collect (preferred specimen): One Dark Green-top Lithium or Sodium Heparin tube. (Minimum Whole Blood: 0.5 mL)
Also acceptable:
One blood gas syringe (see Blood Gas Procedure below).*

Do NOT use Light Green Plasma Separator (PST) tubes.

*NOTE:
Blood Gas specimens should ONLY be collected at the Grosse Pointe, Royal Oak, or Troy Hospital Campuses. Specimens should NOT be collected at any other Beaumont Laboratory drawsite, Nursing Home, or Outreach office.

Blood Gas Procedure: 

  • A 1 mL or 3 mL plastic syringe containing dry heparin is usually used to collect the specimen.
  • At least 1-2 mL (0.3 mL for pediatric patients) of blood is needed to ensure proper assay.
  • Arterial specimens are collected by a physician, nurse, or respiratory therapist.
  • For specimens collected by syringe, any air bubbles present in the syringe must be immediately expelled, the needle removed, and the syringe tightly capped. The syringe is rolled between the palms of the hands to ensure mixing.
    • Note: The Radiometer safePico Self-fill™ syringe has a metal ball to ensure homogeneous mixing when the syringe is rolled between the palms of the hands.
  • Characterization of oxygen enrichment, at the time of arterial puncture, is required. This may be expressed as FiO2 fractional inspired oxygen concentration provided (e.g., 0.50), FiO2% (e.g., 50%), room air, or nasal cannula flow rate in liters per minute. The FiO2 must be noted on the requisition or entered as part of the electronic order for any arterial blood gas specimens. FiO2 is not required for venous blood gas orders.
  • The specimen must be properly labeled.
  • Place on wet ice for transport. Ice and Specimen must be kept separated.
    • Suggested: Place specimen in front pocket of the biohazard bag. Place ice in zip lock section of biohazard bag.
  • The specimen must be transported immediately to the STAT Laboratory (Royal Oak) or to the Chemistry Laboratory (Troy and Grosse Pointe). 

Physician Office/Drawsite Specimen Preparation

Lithium or Sodium Heparin tubes only.
DO NOT remove Vacutainer® stopper. Maintain whole blood specimen refrigerated (2-8°C or 36-46°F) prior to transport. (Min: 0.5 mL)

Preparation for Courier Transport

Transport: Whole blood specimen, refrigerated (2-8°C or 36-46°F). (Min: 0.5 mL)

Rejection Criteria

  • Specimens collected in fluoride or oxalate tubes.
  • Clotted specimens.
  • Specimens not collected and processed as indicated.

Storage

Specimen Stability for Testing:

Green-top Heparin Tubes
Room Temperature (20-26°C or 68-78.8°F): 4 hours
Refrigerated (2-8°C or 36-46°F): 7 days
Frozen (-20°C/-4°F or below): Unacceptable

Blood Gas Syringes

Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): 1 hour
Frozen (-20°C/-4°F or below): Unacceptable

Specimen Storage in Department Prior to Disposal:

Green-top tubes: Refrigerated (2-8°C or 36-46°F) for 7 days.
Blood Gases: Specimens are disposed within 8 hours of testing.

Laboratory

Farmington Hills Chemistry Laboratory.
Grosse Pointe Chemistry Laboratory.
Royal Oak STAT Laboratory.
Troy Chemistry Laboratory.

Performed

Sunday - Saturday, 24 hours a day.
Routine results available within 24 hours.
STAT results available within 1 hour after receipt in the Laboratory.

Reference Range

Non-smoker: Less than 1.5%.
Heavy smoker: Less than 9%.
Toxic: Greater than 20%.

Test Methodology

Absorption Spectrophotometry.

Interpretation

Sulfhemoglobin levels of 10% are reported to increase the HbCO reading by approximately 2.5%.

A high turbidity level corresponding to 5% of Intralipid can affect the HbCO results by +1%.

Clinical Utility

This assay aids in the diagnosis of carbon monoxide poisoning.

CO Hb (%) Symptoms/Signs of Carbon Monoxide Poisoning
10 No appreciable effect; may have tightness across forehead.
20 Short of breath on moderate exertion; occasional headaches.
30 Headache, irritable, easily fatigued.
40-50 Headache, confusion, collapse.
60-70 Unconscious, convulsions, respiratory failure.
80+ Rapidly fatal.

Carbon monoxide combines with the heme Fe2+ of hemoglobin to form carboxyhemoglobin. The binding affinity is about 250 times greater than that of oxygen. In addition to this increased binding affinity with subsequent decreased oxygen content of blood, there is a shift of the hemoglobin oxygen dissociation curve to the left, causing a decrease in release of oxygen from hemoglobin.

CPT Code

82375 (Quantitative), 82376 (Qualitative).

Test Codes

EPIC: LAB5343, SOFT: HGBCO

Last Updated

01/14/2017

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This directory currently reflects information only for specimens collected and/or processed at the Farmington Hills, Grosse Pointe, Royal Oak, and Troy campuses.