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Screening for occupational exposure to chromium
Monitoring metallic prosthetic implant wear
Chromium (Cr) exists in valence states ranging from 2(-) to 6(+). Hexavalent chromium (Cr[+6]) and trivalent chromium (Cr[+3]) are the 2 most prevalent forms. Cr(+6) is used in industry to make chromium alloys including stainless steel, pigments, and electroplated coatings. Cr(+6), a known carcinogen, is immediately converted to Cr(+3) upon exposure to biological tissues. Cr(+3) is the only chromium species found in biological specimens.
Urine chromium concentrations are likely to be increased above the reference range in patients with metallic joint prosthesis. Prosthetic devices produced by Depuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside typically are made of chromium, cobalt, and molybdenum. This list of products is incomplete, and these products change occasionally; see prosthesis product information for each device for composition details.
No established reference values
Chromium is principally excreted in the urine. Urine levels correlate with exposure. Results greater than the reference range indicate either recent exposure to chromium or specimen contamination during collection.
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (8-16 mcg/L) in urine chromium concentration is likely to be associated with a prosthetic device in good condition. Urine concentrations >20 mcg/L in a patient with chromium-based implant suggest significant prosthesis wear. Increased urine trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.
The National Institute for Occupational Safety and Health (NIOSH) draft document on occupational exposure reviews the data supporting use of urine to assess chromium exposure. They recommend a Biological Exposure Index of 10 mcg/g creatinine and 30 mcg/g creatinine for the increase in urinary chromium concentrations during a work shift and at the end of shift at the end of the workweek, respectively. A test for this specific purpose (CHROMU / Chromium for Occupational Monitoring, Urine) is available.
Normal specimens have extremely low levels of chromium; because of the ubiquitous nature of chromium, elevated results could easily be a result of external contamination. Precautions must be taken to ensure the specimen is not contaminated. Metal-free urine collection procedures must be followed (see Trace Metals Analysis Specimen Collection and Transport in Special Instructions).
Refrigeration is preferred over chemical methods of preservation.
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 cannot be collected for 96 hours.
1. Vincent JB: Elucidating a biological role for chromium at a molecular level. Acc Chem Res 2000;33(7):503-510
2. NIOSH Hexavalent Chromium Criteria Document Update, September 2008; Available from URL: http://www.cdc.gov/niosh/topics/hexchrom/
3. Keegan GM, Learmonth ID, Case CP: A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium exposures from industry and surgical implants. Crit Rev Toxicol 2008;38:645-674