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HelpTest Code HMDB Heavy Metals Screen with Demographics, Blood
Useful For
Detecting exposure to arsenic, lead, cadmium, and mercury
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| ASB | Arsenic, B | Yes | Yes |
| PBHMB | Lead, B | Yes, (Order PBDV) | Yes |
| CDB | Cadmium, B | Yes | Yes |
| HG | Mercury, B | Yes | Yes |
| DEMO6 | Patient Demographics | No | Yes |
Method Name
Triple Quadrupole Inductively Coupled Plasma Mass Spectrometry (ICP-MS/MS)
Reporting Name
Heavy Metals Scrn with DemographicsSpecimen Type
Whole bloodNecessary Information
If not ordering electronically, the Lead and Heavy Metals Reporting (T491) is required. Send with specimen.
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: Metal Free B-D Tube (EDTA), 6 mL (T183)
Container/Tube: Royal blue top (EDTA) plastic trace element blood collection tube
Specimen Volume: Full tube
Collection Instructions:
1. See Metals Analysis Specimen Collection and Transport for complete instructions.
2. Send whole blood specimen in original collection tube. Do not aliquot.
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole blood | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Interpretation
Arsenic:
Abnormal blood arsenic concentrations (>12 ng/mL) indicate significant exposure.
Absorbed arsenic is rapidly distributed into tissue storage sites with a blood half-life of less than 6 hours. Unless a blood specimen is drawn within 2 days of exposure, arsenic is not likely to be detected in a blood specimen.
Lead:
For pediatric patients, there may be an association with blood lead values of 5.0 to 9.9 mcg/dL and adverse health effects. The current reference level at which the Centers of Disease Control and Prevention recommends public health actions be initiated is 3.5 mcg/dL in patients 0 to 5 years old and 5 mcg/dL for patients 6 years and older. The most recent National Health and Nutrition Examination Survey (NHANES) data shows that 97.5 percentile for blood lead levels in US adults age 16 years and older is 3.46 mcg/dL. In concurrence with the reference value concept that there is no safe level of lead in blood, the Council of State and Territorial Epidemiologists Occupational Health Subcommittee approved lowering the blood lead threshold from 5 to 3.5 mcg/dL for adults. Follow-up testing after 3 to 6 months may be warranted.
Chelation therapy is indicated when whole blood lead concentration is greater than 25.0 mcg/dL in children or greater than 45.0 mcg/dL in adults.
The Occupational Safety and Health Administration has published the following standards for employees working in industry:
-Employees with a single whole blood lead result greater than 60.0 mcg/dL must be removed from workplace exposure.
-Employees with whole blood lead levels greater than 50.0 mcg/dL averaged over 3 blood samplings must be removed from workplace exposure.
-An employee may not return to work in a lead exposure environment until their whole blood lead level is less than 40 mcg/dL.
New York State has mandated inclusion of the following statement in reports for children under the age of 6 years with blood lead in the range of 5.0 to 9.9 mcg/dL: "Blood lead levels in the range of 5.0-9.9 mcg/dL have been associated with adverse health effects in children aged 6 years and younger."
Cadmium:
Normal blood cadmium concentration is less than 5.0 ng/mL, with most results in the range of 0.5 to 2.0 ng/mL.
Acute toxicity will be observed when the blood level exceeds 50 ng/mL.
Mercury:
The quantity of mercury (Hg) found in blood and urine correlates with degree of toxicity. Hair analysis can be used to document the time of peak exposure if the event was in the past.
Normal whole blood mercury concentration is usually less than 10 ng/mL.
Individuals who have mild exposure during work, such as dentists, may routinely have whole blood mercury levels up to 15 ng/mL.
Significant exposure is indicated when the whole blood mercury concentration is greater than 50 ng/mL if exposure is due to alkyl Hg, or greater than 200 ng/mL if exposure is due to Hg(2+).
Clinical Reference
1. Lee R, Middleton D, Calwell K, et al. A review of events that expose children to elemental mercury in the United States. Environ Health Perspect. 2009;117(6):871-878
2. Hall M, Chen Y, Ahsan H, et al. Blood arsenic as a biomarker of arsenic exposure: results from a prospective study. Toxicology. 2006;225(2-3):225-233
3. Centers for Disease Control and Prevention (CDC). National Report on Human Exposure to Environmental Chemicals. CDC; Updated September 29, 2023. Accessed October 23, 2023. Available at www.cdc.gov/exposurereport
4. de Burbure C, Buchet J-P, Leroyer A, et al. Renal and neurologic effects of cadmium, lead, mercury, and arsenic in children: evidence of early effects and multiple interactions at environmental exposure levels. Environ Health Perspect. 2006;114(4):584-590
5. Kosnett MJ, Wedeen RP, Rothenberg SJ, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115(3):463-471
6. Jusko T, Henderson C, Lanphear B, Cory-Slechta DA, Parsons PJ, Canfield RL. Blood lead concentrations <10 mcg/dL and child intelligence at 6 years of age. Environ Health Perspect. 2008;116(2):243-248
7. Moreau T, Lellouch J, Juguet B, Claude JR, Juguet B, Festy B. Blood cadmium levels in a general population with special reference to smoking. Arch Environ Health. 1983;38(3):163-167
8. Bjorkman L, Lundekvam B, Laegreid T, et al. Mercury in human brain, blood, muscle and toenails in relation to exposure: an autopsy study. Environ Health. 2007;6:30
9. deBurbure C, Buchet JP, Leroyer A, et al. Renal and neurologic effects of cadmium, lead, mercury, and arsenic in children: evidence of early effects and multiple interactions at environmental exposure levels. Environ Health Perspect. 2006;114(4):584-590
10. Strathmann FG, Blum LM: Toxic elements. In: Rifai N, Chiu RWK, Young I, Burnham CD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 44
11. CSTE Occupational Subcommittee. Management Guidelines for Blood Lead Levels in Adults. 2021. Accessed October 23, 2023. Available at: https://cdn.ymaws.com/www.cste.org/resource/resmgr/occupationalhealth/publications/ManagementGuidelinesforAdult.pdf
Day(s) Performed
Monday through Saturday
Report Available
1 to 2 daysPerforming 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
82175
82300
83655
83825
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| HMDB | Heavy Metals Scrn with Demographics | 29588-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 32190 | Arsenic, B | 5583-0 |
| 8682 | Cadmium, B | 5609-3 |
| 8618 | Mercury, B | 5685-3 |
| 2588 | Lead, B | 77307-7 |
| VECP6 | Venous/Capillary | 31208-2 |
| PTAD6 | Patient Street Address | 56799-0 |
| PTCI6 | Patient City | 68997-6 |
| PTST6 | Patient State | 46499-0 |
| PTZI6 | Patient Zip Code | 45401-7 |
| PTCN6 | Patient County | 87721-7 |
| PTPH6 | Patient Home Phone | 42077-8 |
| PTRA6 | Patient Race | 32624-9 |
| PTET6 | Patient Ethnicity | 69490-1 |
| PTOC6 | Patient Occupation | 11341-5 |
| PTEM6 | Patient Employer | 80427-8 |
| GDFN6 | Guardian First Name | 79183-0 |
| GDLN6 | Guardian Last Name | 79184-8 |
| MDOR6 | Health Care Provider Name | 52526-1 |
| MDAD6 | Health Care Provider Street Address | 74221-3 |
| MDCI6 | Health Care Provider City | 52531-1 |
| MDST6 | Health Care Provider State | 52532-9 |
| MDZI6 | Health Care Provider Zip Code | 87720-9 |
| MDPH6 | Health Care Provider Phone | 68340-9 |
| LABP6 | Submitting Laboratory Phone | 65651-2 |
Special Instructions
Specimen Minimum Volume
0.3 mL
Reference Values
ARSENIC
<13 ng/mL
Reference values apply to all ages.
LEAD
<3.5 mcg/dL
Critical values
Pediatrics (≤15 years): ≥20.0 mcg/dL
Adults (≥16 years): ≥70.0 mcg/dL
CADMIUM
<5.0 ng/mL
Reference values apply to all ages.
MERCURY
<10 ng/mL
Reference values apply to all ages.
Testing Algorithm
For more information see Porphyria (Acute) Testing Algorithm
Forms
Lead and Heavy Metals Reporting (T491) or Lead and Heavy Metals Reporting-Spanish (T956)