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Test Code COWB Cobalt, Blood


Ordering Guidance


This test should not be ordered to assess vitamin B12 activity. For that assessment see B12 / Vitamin B12 Assay, Serum or ACASM / Pernicious Anemia Cascade, Serum.

 

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.



Specimen Required


Container/Tube: Royal blue top (EDTA) Vacutainer plastic trace element blood collection tube

Specimen Volume: 1 mL

Collection Instructions:

1. See Metals Analysis Specimen Collection and Transport for complete instructions

2. Send whole blood specimen in original tube. Do not aliquot.


Useful For

Monitoring exposure to cobalt using whole blood specimens

 

Monitoring metallic prosthetic implant wear

 

This test is not useful for assessment of vitamin B12 activity.

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Reporting Name

Cobalt, B

Specimen Type

Whole blood

Specimen Minimum Volume

0.3 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Whole blood Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Reference Values

0-17 years: Not established

≥18 years: <1.0 ng/mL

Interpretation

Concentrations of 1.0 ng/mL and above indicate possible environmental or occupational exposure.

 

Cobalt concentrations associated with toxicity must be interpreted in the context of the source of exposure. In the context of failed metal-on-metal prosthetics, elevated cobalt in serum or blood is rarely the initial finding and is often preceded by physical symptoms including reduced range of motion, swelling, inflammation around the joints, and general discomfort or pain.

 

The American Conference of Governmental Industrial Hygienists (ACGIH) Biological Exposure Index (BEI) for cobalt in blood is 1 mcg/L (1 ng/mL), which should be collected at the end of shift at the end of the work week.

Clinical Reference

1. 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(17):2847-2851

2. Keegan GM, Learmonth ID, Case CP. A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium from industry and surgical implants. Crit Rev Toxicol. 2008;38(8):645-674

3. De Smet K, De Hann R, Calistri A, et al. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am. 2008;90 Sppl 4:202-208

4. Lison D, De Boeck M, Verougstraete V, Kirsch-Volders M. Update on the genotoxicity and carcinogenicity of cobalt compounds. Occup Environ Med. 2001;58(10):619-625

5. 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

6. U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. Toxicology profile for cobalt. HHS; April 2004. Accessed October 17, 2023. Available at www.atsdr.cdc.gov/ToxProfiles/tp33.pdf

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.

8. Crutsen JRW, Koper MC, Jelsma J, et al. Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports. EFORT Open Rev. 2022;7(3):188-199

9. Leyssens L, Vinck B, Van Der Straeten C, Wuyts F, Maes L. Cobalt toxicity in humans-A review of the potential sources and systemic health effects. Toxicology. 2017;387:43-56. doi: 10.1016/j.tox.2017.05.015

Day(s) Performed

Tuesday, Wednesday, Friday

Report Available

1 to 4 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

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
COWB Cobalt, B 5625-9

 

Result ID Test Result Name Result LOINC Value
60355 Cobalt, B 5625-9