NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Determination of silver exposure
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
Inductively Coupled Plasma-Mass Spectrometry (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 Vacutainer plastic trace element blood collection tube, catalog #368380 (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 pipet 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 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 bacteriostatic properties of silver have long been recognized. In the 19th century, silver nitrate was used to treat gonorrheal ophthalmia in the newborn. Current medical uses of silver-containing compounds include sulfadiazine ointment for burn patients and some nasal decongestants. Silver-coated sutures and catheters have shown some effectiveness against a broad range of bacteria. Colloidal silver is contained in various over-the-counter preparations sold in health food stores.
Environmental silver exposure can be the result of manufacture of silver nitrates as germicides, antiseptics, caustics, and analytical reagents; and for use in photography, mirrors, plating, inks, dyes, and porcelain. Additionally, sources of exposure include manufacture of silver salts as catalysts in oxidation-reduction and polymerization reactions; in chemical synthesis, in glass manufacture, in silver plating, as laboratory reagents, and in medicinal compounds.
Silver is not an essential constituent of the human body. Silver metabolism in humans has been inadequately studied and little reliable data is available. Some individuals seem to absorb silver selectively. Silver deposits in many organs, including the subepithelium of skin and mucous membranes producing a syndrome called argyria (greying of the skin). Argyria is associated with growth retardation, hemopoiesis, cardiac enlargement, degeneration of the liver, and destruction of renal tubules.
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.
A finding of silver >1,000 ng/mL is indicative of acute silver exposure. Argyria occurs when silver levels are >2,000 ng/mL. No link between moderately elevated silver serum levels and symptoms has been reported in peer-reviewed medical literature.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Urine silver analysis is not an acceptable alternative to this test; studies have demonstrated silver is rapidly lost from urine specimens under all routine preservation conditions.
High concentrations of gadolinium and iodine are known to interfere with most metals tests. If 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. Leon-Villapalos J, Jeschke MG, Herndon DN. Topical management of facial burns. Burns 2008;34:903-911
2. Lansdown AB. Critical Observations on the Neurotoxicity of Silver. Critical Reviews in Toxicology 2007;37:237–250
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. Calibrating standards and blanks are diluted with an aqueous acidic diluent containing internal standard(s). 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 amu 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. (Unpublished Mayo Method)
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.
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|