Test Catalog

Test Id : HMNA

Heavy Metals, Nails

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

Detection of nonacute arsenic, mercury, and lead exposure

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
ASNA Arsenic, Nails Yes Yes
PBNA Lead, Nails Yes Yes
HGNA Mercury, Nails Yes Yes

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

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.

No

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

Heavy Metals, Nails

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

Arsenic (As)

As (Arsenic)

Hg (Mercury)

Lead (Pb)

Mercury (Hg)

Pb (Lead)

Specimen Type
Describes the specimen type validated for testing

Nail

Necessary Information

Indicate source of nails (fingernails or toenails), if known

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

Supplies: Hair and Nails Collection Kit (T565)

Specimen Volume: 0.2 g

Collection Instructions:

1. Prepare and transport specimen per the instructions in the kit or see Collecting Hair and Nails for Metals Testing in Special Instructions.

2. Clippings should be taken from all 10 fingernails or toenails.

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

0.05 g

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

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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
Nail Ambient (preferred)
Frozen
Refrigerated

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

Detection of nonacute arsenic, mercury, and lead exposure

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

Arsenic

Arsenic circulating in the blood will bind to protein by formation of a covalent complex with sulfhydryl groups of the amino acid cysteine. Keratin, the major structural protein in hair and nails, contains many cysteine residues and, therefore, is one of the major sites for accumulation of arsenic. Since arsenic has a high affinity for keratin, the concentration of arsenic in nails is higher than in other tissues.

 

Several weeks after exposure, transverse white striae, called Mees' lines, may appear in the fingernails

 

Mercury

Once absorbed and circulating, mercury becomes bound to numerous proteins, including keratin. The concentration of mercury in nails correlates with the severity of clinical symptoms. If the nails can be segregated by length, such an exercise may be useful in identifying the time of exposure.

 

Lead

Nail analysis of lead can be used to corroborate blood analysis.

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.

ARSENIC

0-15 years: not established

> or =16 years: <1.0 mcg/g of nails

 

LEAD

<4.0 mcg/g of nails

Reference values apply to all ages.

 

MERCURY

0-15 years: not established

> or =16 years: <1.0 mcg/g of nails

Interpretation
Provides information to assist in interpretation of the test results

Nails grow at a rate of approximately 0.1 inch/month. Nail keratin synthesized today will grow to the distal end in approximately 6 months. Thus, a nail specimen collected at the distal end represents exposure of 6 months ago.

 

ARSENIC

Nail arsenic above 1.0 mcg/g dry weight may indicate excessive exposure. It is normal for some arsenic to be present in nails, as everybody is exposed to trace amounts of arsenic from the normal diet.

 

The highest hair or nail arsenic observed at Mayo Clinic was 210 mcg/g dry weight in a case of chronic exposure, which was the cause of death.

 

MERCURY

Normally, nails contain less than 1 mcg/g of mercury; any amount above this indicates that exposure to more than normal amounts of mercury may have occurred.

 

LEAD

Normally, the nail lead content is below 4.0 mcg/g. While nail lead content above 10.0 mcg/g may indicate significant lead exposure, nails are also subject to potential external contamination with environmental lead. Ultimately, the nail lead content needs to be interpreted in addition to the overall clinical scenario including symptoms, physical findings, and other diagnostic results when determining further actions.

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

No significant cautionary statements

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

1. Hindmarsh JT, McCurdy RF: Clinical and environmental aspects of arsenic toxicity. Crit Rev Clin Lab Sci. 1986;23:315-347

2. Strumylaite L, Ryselis S, Kregzdyte R: Content of lead in human hair from people exposed to lead. Int J Hyg Environ Health. 2004;207:345-351

3. Barbosa F, Tanus-Santos J, Gerlach R, Parsons P: A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Environ Health Perspect. 2005;113:1669-1674

4. Sanna E, Liguori A, Palmes L, et al: Blood and hair lead levels in boys and girls living in two Sardinian towns at different risks of lead pollution. Ecotoxicol Environ Saf. 2003;500:293-299

5. DiPietro ES, Phillips DL, Paschal DC, Neese JW. Determination of trace elements in human hair. Biol Trace Elem Res. 1989;22:83-100

6. Strathmann FG, Blum LM: Toxic elements. In: Nader R, Horwath AR, Wittwer CT, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:chap 42

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

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

Arsenic, mercury, and lead in nails are analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) in kinetic energy discrimination (KED) mode using gallium, iridium, and lutetium as internal standards, and a salt matrix calibration.(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

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.

2 to 7 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 Regional Manager. 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. This test 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.

82175-Arsenic

83655-Lead

83825-Mercury

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 | 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