NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Detecting vanadium toxicity
Monitoring metallic prosthetic implant wear
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
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
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.
Collection Container/Tube: Plain, royal-blue top Monoject trace element blood collection tube, product #8881-307006 (Supply T184)
Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial (Supply T173)
Specimen Volume: 1.6 mL
1. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.
2. Remove the stopper. Carefully pour specimen into Mayo metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Do not insert a pipette into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.
3. 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.
Mild OK; Gross OK
Mild OK; Gross OK
Mild OK; Gross reject
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
|Serum||Refrigerated (preferred)||7 days|
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
The element vanadium, naturally found in minerals and rocks, is considered an essential element for mammals, although conclusive evidence for humans is lacking. Animal studies have shown that vanadium is essential for mammalian growth and reproduction, iron and lipid metabolism, and RBC production.
Vanadium is recovered from minerals or as a by-product of iron, titanium, and uranium refining. Vanadium pentoxide is used in the production of special steels. Vanadium compounds are used as catalysts for polypropylene production and synthesis of inorganic and organic chemicals. Vanadium compounds are used in dyes, photography, ceramics, and in the production of special glasses. Vanadium also is a component of a fiber mesh prosthetic alloy.
The main source of vanadium intake for the general population is food, with an estimated daily intake of 20 mcg, of which most is excreted in the feces, without absorption. Absorption through the inhalation route results in more effective uptake. About 90% of blood vanadium is found in serum. The half-life in serum is not well documented, but it appears to be on the order of several days. Although there is minimal evidence for the nature of vanadium complexation in the body, research suggests transferrin will bind available ionized vanadium.
Currently, there is no clinical data to support the need for taking vanadium supplements such as vanadyl sulfate, vanadium colloid, or any other form. This test provides no information regarding any theoretical vanadium deficiency.
Vanadium has been recognized as an occupational hazard for >20 years. Elevated atmospheric vanadium levels can result from burning fossil fuels with a high vanadium content. Inhalation and ingestion are the primary exposure routes. Vanadium exposure can result in a metallic taste and so-called "green tongue." Sensitization can result in asthma or eczema. Vanadium intoxication is effectively treated with ascorbic acid.
Increased vanadium serum concentrations are observed in dialysis patients and those with compromised renal function since the kidney is primarily responsible for vanadium elimination. Elevated serum vanadium levels have been observed in patients with joint replacements; concentrations are likely to be increased above the reference range in patients with metallic joint prosthesis. Prosthetic devices produced by Zimmer Company and Johnson & Johnson typically are made of aluminum, vanadium, and titanium. 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.
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: <1.0 ng/mL
Values <1.0 ng/mL are normal. Values >5.0 ng/mL indicate probable exposure.
Prosthesis wear is known to result in increased circulating concentration of metal ions.(2-3) Modest increase (1-2 ng/mL) in serum vanadium concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations >5 ng/mL in a patient with a vanadium-based implant suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Specimen collection procedures require special collection containers, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless all of these procedures are followed, increased serum vanadium results may be an incidental and misleading finding.
This test should be ordered only when there is reason to suspect vanadium exposure. There is still controversy as to the effects of industrial exposure on the body and toxicity data is extremely limited.
Although vanadium appears to be an essential trace element in humans, its role, if any, is not clearly defined and this test is not useful for nutritional assessment.
Currently, there is no evidence to suggest the clinical utility of monitoring vanadium levels in either dialysis patients or those with prosthetic joints. In cases where the fiber mesh alloy has deteriorated, aluminum can be measured.
There is no clear evidence to support the preference for either serum or urine as the specimen of choice for monitoring exposure. Under no circumstance is hair or nail testing advisable.
Due to possible contamination or binding of vanadium with anticoagulants, plasma testing is not recommended.
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.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Liu TK, Liu SH, Chang CH, Yang RS: Concentration of metal elements in the blood and urine in the patients with cementless total knee arthroplasty. Tohoku J Exp Med 1998 August;185:253-262
2. Lhotka C, Szekes T, Stefan I, et al: Four-year study of cobalt and chromium blood levels in patients managed with two different metal-on-metal total hip replacements. J Orthop Res 2003 March;21:189-195
Method Description Describes how the test is performed and provides a method-specific reference
This assay is performed on an inductively coupled plasma-mass spectrometer in dynamic reaction cell mode. 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 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 concentration 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, Neubauer KR, Eckdahl SJ, et al: Evaluation of a tunable bandpass reaction cell for an inductively coupled plasma mass spectrometer for the determination of chromium and vanadium in serum and urine. Spectrochimica Acta Part B-Atomic Spectroscopy 2002;57;951-966)
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.
Tuesday, Thursday; 3 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.
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.
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.
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|