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Epic Code LAB750 Chromium, Serum

Important Note

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Additional Codes

Mayo Code: CRS

Epic Code: LAB 750

Interface Order Alias: 10338

Cerner Code: 4067

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Screening for occupational exposure

 

Monitoring metallic prosthetic implant wear

Specimen Type

Serum


Ordering Guidance


The US Food and Drug Administration recommended test for monitoring chromium in patients with metal-on-metal implants is CRWB / Chromium, Blood.



Specimen Required


Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Supplies: Metal Free Specimen Vial (T173)

Collection Container/Tube: Plain, royal blue-top Vacutainer plastic trace element blood collection tube

Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial

Specimen Volume: 0.5 mL

Collection Instructions:

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 Specimen Collection and Transport for complete instructions.


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days METAL FREE
  Ambient  28 days METAL FREE
  Frozen  28 days METAL FREE

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Day(s) Performed

Tuesday, Wednesday, Friday

Reference Values

<0.3 ng/mL

 

When collected by a phlebotomist experienced in ultra-clean collection technique and handled according to the instructions in Metals Analysis Specimen Collection and Transport, we have observed the concentration of chromium in serum to be below 0.3 ng/mL. However, the majority of specimens submitted for analysis from unexposed individuals contain 0.3 ng/mL to 0.9 ng/mL of chromium. Commercial evacuated blood collection tubes not designed for trace-metal specimen collection yield serum containing 2.0 ng/mL to 5.0 ng/mL chromium derived from the collection tube.

Clinical Information

Chromium (Cr) exists in valence states. 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.

Cautions

Specimens from unexposed individuals collected using metal-free collection procedures typically have chromium above 0.3 ng/mL. Chromium is present in our environment at 100-fold to 1000-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 Clinic 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.

Interpretation

Results greater than the flagged value indicate clinically significant exposure to chromium (Cr) (see Cautions about specimen collection). The reported units of measurement for chromium of ng/mL is equivalent to mcg/L.

 

Prosthesis wear is known to result in an increased circulating concentration of metal ions. A 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 above 1 ng/mL in a patient with a 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. However, the US Food and Drug Administration recommends testing chromium in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.

Reporting Name

Chromium, S

Method Name

Inductively Coupled Plasma-Mass Spectometry (DRC-ICP-MS)

Method Description

The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)

CPT Code Information

82495

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CRS Chromium, S 5622-6

 

Result ID Test Result Name Result LOINC Value
8638 Chromium, S 5622-6

Report Available

1 to 4 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

Clinical Reference

1. Vincent JB. Elucidating a biological role for chromium at a molecular level. Acc Chem Res. 2000;33(7):503-510

2. Centers for Disease Control and Prevention, The National Institute for Occupational Safety and Health (NIOSH): Criteria for a Recommended Standard for an Occupational Exposure to Hexavalent Chromium. September 2013. Accessed October 22, 2023. CDC; Available at www.cdc.gov/niosh/docs/2013-128/pdfs/2013_128.pdf

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

5 Eliaz N. Corrosion of metallic biomaterials: A Review. Materials (Basel). 2019;12(3):407. doi:10.3390/ma12030407

6. US Food and Drug Administration: Information about Soft Tissue Imaging and Metal Ion Testing. FDA; Updated March 15, 2019. Accessed October 17, 2023. Available at www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/MetalonMetalHipImplants/ucm331971.htm

7. Sodi R. Vitamins and trace elements. Rifai N, Chiu RWK, Young I, eds: Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 39

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