Test Catalog

Test Id : CRWB

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Chromium, Blood

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring exposure to chromium using whole blood specimens

 

Monitoring metallic prosthetic implant wear

Method Name
A short description of the method used to perform the test

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Chromium, B

Aliases
Lists additional common names for a test, as an aid in searching

Chromium (Cr)

Cr (Chromium)

Specimen Type
Describes the specimen type validated for testing

Whole blood

Ordering Guidance

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
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

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.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.3 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK
Microtainer Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

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

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring exposure to chromium using whole blood specimens

 

Monitoring metallic prosthetic implant wear

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Chromium (Cr) is a naturally occurring element widely distributed in the environment. Chromium exists in several valence states with the 3 main forms being Cr, Cr(3+), and Cr(6+). Cr(3+) is an essential trace element that enhances the action of insulin. Deficiency leads to impaired growth, reduced life span, corneal lesions, and alterations in carbohydrates, lipid, and protein metabolism.

 

Chromium is widely used in manufacturing processes to make various metal alloys such as stainless steel. It is also used in many consumer products including wood treated with copper dichromate, leather tanned with chromic sulfate, and metal-on-metal hip replacements.

 

The general population is most likely to be exposed to trace levels of chromium in the food that is eaten. Low levels of Cr(3+) occur naturally in a variety of foods, such as fruits, vegetables, nuts, beverages, and meats. The highest potential occupational exposure occurs in the metallurgy and tanning industries, where workers may be exposed to high air concentrations.

 

Per US Food and Drug Administration recommendations, orthopedic surgeons should consider measuring and following serial chromium concentrations in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal hip implants as part of their overall clinical evaluation. Blood 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.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

0-17 years: Not established

> or =18 years: <1.0 ng/mL

Interpretation
Provides information to assist in interpretation of the test results

Results greater than the reference range indicate exposure to chromium (see Cautions about specimen collection).

 

Prosthesis wear is known to result in increased circulating concentration of metal ions. Increased blood trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Chromium is present in the environment at 100-fold to 1000-fold higher concentration than found in biological tissues. Reports of increased blood chromium could be due to external contamination. Metal-free blood collection procedures must be followed.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

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; National Institute for Occupational Safety and Health (NIOSH): Criteria for a recommended standard occupational exposure to hexavalent chromium. CDC; September 2013. Accessed October 17, 2023. 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(17):2847-2851

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. US Department of Health and Human Services, Agency for Toxic Substances and Disease Registry: Toxicology profile for chromium. HHS; September 2012. Accessed March 2, 2021. Available at www.atsdr.cdc.gov/ToxProfiles/tp7.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. Eliaz N. Corrosion of metallic biomaterials: A review. Materials (Basel). 2019;12(3):407. doi:10.3390/ma12030407

Method Description
Describes how the test is performed and provides a method-specific reference

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

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Tuesday, Wednesday, Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

1 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82495

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CRWB Chromium, B 5619-2
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
65601 Chromium, B 5619-2

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | PHP Pdf | CMS Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports