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Test Code ALWB Aluminum, Blood


Specimen Required


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

Supplies:

-Greiner Bio-One VACUETTE TUBE 6 mL NH Trace Elements Sodium Heparin tube (T819)

-Metal Free Specimen Vial (T173)

Container/Tube: Greiner Bio-One VACUETTE TUBE 6 mL NH Trace Elements Sodium Heparin tube

Specimen Volume: 1 mL

Collection Instructions: See Metals Analysis Specimen Collection and Transport for complete instructions.


Useful For

Preferred test for routine aluminum screening

 

Monitoring metallic prosthetic implant wear

Method Name

Triple-Quadrupole Inductively Coupled Plasma Mass Spectrometry (ICP-MS/MS)

Reporting Name

Aluminum, B

Specimen Type

Whole blood

Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time
Whole blood Refrigerated 14 days

Reference Values

0-17 years: Not established

≥18 years: <5 ng/mL

Interpretation

Internal exposure, which can be determined from aluminum levels in blood, is a significantly better measure for assessing aluminum-related neurotoxicity. Early signs of neurotoxicity have been reported in plasma concentrations starting at 13 ng/mL, but any elevation must take into account the full clinical history and other clinical signs and symptoms and test results. Previous studies have reported a whole blood to serum ratio for aluminum of approximately 1.7.(1)

 

The McCarthy(2) and Hernandez(3) describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:

-Patients in kidney failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum below 20 ng/mL and parathyroid hormone (PTH) concentrations above 150 pg/mL, which is typical of secondary hyperparathyroidism.

-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum above 60 ng/mL and PTH concentrations below 50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).

-Patients who had serum aluminum above 60 ng/mL but below 100 ng/mL were identified as candidates for later onset of aluminum-overload disease and required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had less than 10 ng/mL of aluminum, and ensuring the albumin used during postdialysis therapy was aluminum free.

 

Prosthesis wear is known to result in increased circulating concentration of metal ions.(4) A modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

Clinical Reference

1. Schultze B, Lind PM, Larsson A, Lind L. Whole blood and serum concentrations of metals in a Swedish population-based sample. Scand J Clin Lab Invest. 2014;74(2):143-148. doi:10.3109/00365513.2013.864785

2. McCarthy JT, Milliner DS, Kurtz SB, Johnson WJ, Moyer TP. Interpretation of serum aluminum values in dialysis patients. Am J Clin Pathol. 1986;86(5):629-636

3. Hernandez JD, Wesseling K, Salusky IB. Role of parathyroid hormone and therapy with active vitamin D sterols in renal osteodystrophy. Semin Dial. 2005;18(4):290-295

4. 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;185(4):253-262

5. Schwarz C, Sulzbacher R, Oberbauer R. Diagnosis of renal osteodystrophy. Eur J Clin Invest. 2006;36 Suppl 2:13-22

6. Sharma AK, Toussaint ND, Pickering J, Beeston T, Smith ER, Holt SG. Assessing the utility of testing aluminum levels in dialysis patients. Hemodial Int. 2015;19(2):256-262 doi:10.1111/hdi.12231

7. Riihimaki V, Aitio A. Occupational exposure to aluminum and its biomonitoring in perspective. Crit Rev Toxicol. 2012;42(10):827-853 doi:10.3109/10408444.2012.725027

8. Strathmann FG, Blum LM. Toxic elements In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:455e55

9. US Department of Health and Human Services. Toxicological profile for aluminum. HHS: Agency for Toxic Substances and Disease Registry. 2006. Accessed August 29, 2023. Available at www.atsdr.cdc.gov/toxprofiles/tp22.pdf

10. Willhite CC, Karyakina NA, Yokel RA, et al. Systematic review of potential health risks posed by pharmaceutical, occupational and consumer exposures to metallic and nanoscale aluminum, aluminum oxides, aluminum hydroxide, and its soluble salts. Crit Rev Toxicol. 2014;44 Suppl 4(Suppl 4):1-80. doi:10.3109/10408444.2014.934439

11. Kazi TG, Jalbani N, Kazi N, et al. Evaluation of toxic metals in blood and urine samples of chronic renal failure patients, before and after dialysis. Ren Fail. 2008;30(7):737-45. doi:10.1080/08860220802212999

12. Chuang PH, Tsai KF, Wang IK, et al. Blood Aluminum Levels in Patients with Hemodialysis and Peritoneal Dialysis. Int J Environ Res Public Health. 2022;19(7):3885. doi:10.3390/ijerph19073885

13. Rucker D, Thadhani R, Tonelli M. Trace element status in hemodialysis patients. Semin Dial. 2010;23(4):389-395

14. Klotz K, Weistenhofer W, Neff F, Hartwig A, van Thriel C, Drexler H. The Health Effects of Aluminum Exposure. Dtsch Arztebl Int. 2017;114(39):653-659. doi:10.3238/arztebl.2017.0653

Day(s) Performed

Tuesday through Friday

Report Available

1 to 5 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

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.

CPT Code Information

82108

LOINC Code Information

Test ID Test Order Name Order LOINC Value
ALWB Aluminum, B 5575-6

 

Result ID Test Result Name Result LOINC Value
622056 Aluminum, B 5575-6