NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Screening for occupational exposure
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 Spectometry (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 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 a 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 either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
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
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.
Serum Cr 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.
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.
When collected by a phlebotomist experienced in ultra-clean collection technique and handled according to the instructions in Metals Analysis-Collection and Transport in Special Instructions, we have observed the concentration of chromium in serum to be <0.3 ng/mL. However, the majority of specimens submitted for analysis from unexposed individuals contain 0.3-0.9 ng/mL of chromium. Commercial evacuated blood collection tubes not designed for trace-metal specimen collection yield serum containing 2.0-5.0 ng/mL chromium derived from the collection tube.
Results greater than the flagged value indicate clinically significant exposure to chromium (Cr) (see Cautions about specimen collection).
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (0.3-0.6 ng/mL) in serum Cr concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations >1 ng/mL in a patient with Cr-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
Specimens from unexposed individuals collected using metal-free collection procedures typically have chromium >0.3 ng/mL. Chromium is present in our environment at 100-fold to 1,000-fold higher concentration than found in biological tissues. Reports of increased serum chromium could be due to external contamination. Metal-free serum collection procedures must be followed, and centrifuged serum must be aliquoted into a Mayo Medical Laboratories metal-free vial to avoid external contamination. Specimens collected using an anticoagulant are unacceptable; trace amounts of chromium are present in anticoagulants used in evacuated collection tubes.
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 can not be collected for 96 hours.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Vincent JB: Elucidating a biological role for chromium at a molecular level. Acc Chem Res 2000 July;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
4. Tower SS: Arthroprosthetic cobaltism: Neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: A case report. J Bone Joint Surg Am 2010;92:1-5
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 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 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.
Tuesday through Friday; 8 a.m.-11 a.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|