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HelpTest Code CRS Chromium, Serum
Reporting Name
Chromium, SUseful For
Screening for occupational exposure
Monitoring metallic prosthetic implant wear
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering 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.
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 |
Special Instructions
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.
Day(s) Performed
Tuesday, Wednesday, Friday
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
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 |
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.
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
Report Available
1 to 4 daysMethod Name
Inductively Coupled Plasma-Mass Spectometry (DRC-ICP-MS)