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Test Catalog

Test ID: CRWB    
Chromium, Blood

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(0), Cr(III), and Cr(VI). Cr(III) 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(III) 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 FDA 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 (Cr) (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 July;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. September 2013. Accessed November 06, 2020. 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 Dec;92(17):2847-2851

5. US Food and Drug Administration: Information about Soft Tissue Imaging and Metal Ion Testing. Updated March 15, 2019. Accessed March 2, 2021. 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. September 2012. Accessed March 2, 2021. Available at www.atsdr.cdc.gov/ToxProfiles/tp7.pdf

7. Rifai N, Horwath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018

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