Test Id : MNB
Manganese, Blood
Useful For
Suggests clinical disorders or settings where the test may be helpful
Evaluation of central nervous system symptoms, similar to Parkinson disease, in manganese (Mn) miners and processors
Characterization of liver cirrhosis
Therapeutic monitoring in treatment of cirrhosis, parenteral nutrition-related Mn toxicity, and environmental exposure to Mn
Method Name
A short description of the method used to perform the test
Triple-Quadrupole Inductively Coupled Plasma-Mass Spectrometry (ICP-MS/MS)
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Specimen Type
Describes the specimen type validated for testing
Whole blood
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
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 EDTA 3 mL Tube (T989)
-Metal Free B-D Tube (EDTA), 6 mL (T183)
Container/Tube:
Preferred: Royal blue-top BD vacutainer with EDTA blood collection tube (3 mL) (BD catalog no. 367777) (T989)
Acceptable: Royal blue-top BD Vacutainer Plus with EDTA blood collection tube (6 mL) (BD catalog no. 368381) (T183)
Specimen Volume: 0.3 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. The minimum volume is sufficient for one attempt at testing.
0.2 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 |
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
Evaluation of central nervous system symptoms, similar to Parkinson disease, in manganese (Mn) miners and processors
Characterization of liver cirrhosis
Therapeutic monitoring in treatment of cirrhosis, parenteral nutrition-related Mn toxicity, and environmental exposure to Mn
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Manganese (Mn) is a trace essential element with many industrial uses. Mining as well as iron and steel production have been implicated as occupational sources of exposure. It is principally used in steel production to improve hardness, stiffness, and strength. Mn is a normal constituent of air, soil, water, and food. The primary nonoccupational source of exposure is by eating food or Mn-containing nutritional supplements. Vegetarians who consume foods rich in Mn such as grains, beans, and nuts, as well as heavy tea drinkers, may have a higher intake than the average person. People who smoke tobacco or inhale second-hand smoke are also exposed to Mn at higher levels than nonsmokers.
Inhalation is the primary source of entry for Mn but is also partially absorbed (3%-5%) through the gastrointestinal tract. Only very small amounts of Mn are absorbed dermally. Signs of toxicity may appear quickly, and neurological symptoms are rarely reversible. Mn toxicity is generally recognized to progress through 3 stages. Levy describes these stages. "The first stage is a prodrome of malaise, somnolence, apathy, emotional lability, sexual dysfunction, weakness, lethargy, anorexia, and headaches. If there is continued exposure, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgement, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthria, axial and extremity dystonia, paresis, gait disturbances, cogwheel rigidity, intention tremor, impaired coordination, and a mask-like face. Many of those affected may be permanently and completely disabled."(1) Mn is removed from the blood by the liver where it's conjugated with bile and excreted.
The major compartment for circulating Mn is the erythrocytes, bound to hemoglobin, with whole blood concentrations of Mn (in patients with normal levels) being 10 times that of the serum. Mn passes from the blood to the tissues quickly. Concentrations in the liver are highest, with 1 to 1.5 mg Mn/kg (wet weight) in normal individuals. The half-life of Mn in the body is about 40 days, with elimination primarily through the feces. Only small amounts are excreted in the urine.
Elevated levels of whole blood Mn have been reported, with and without central nervous system (CNS) symptoms, in patients with hepatitis B virus-induced liver cirrhosis, in patients on total parenteral nutrition (TPN) with Mn supplementation, and in infants born to mothers who were on TPN. The studies in cirrhotic patients with extrapyramidal symptoms indicate a possible correlation between whole blood Mn and that measured by T1-weighted magnetic resonance in the globus pallidus and midbrain, with whole blood Mn levels being 2-fold or more, higher than normal. Increases in whole blood Mn over time may be indicative of future CNS effects. The data on TPN patients is based on anecdotes or small studies and is highly variable, as is that obtained in infants.(2)
Behcet disease, a form of chronic systemic vasculitis, has been reported to exhibit 4-fold increase in erythrocyte Mn, and it is suggested that increased activity of superoxide dismutase may contribute to the pathogenesis of the disease.
Mn has also been reported as a contaminant in "garage" preparations of the abused drug methcathinone. Continued use of the drug gives rise to CNS toxicity typical of manganism.(3)
For monitoring therapy, whether of environmental exposure, TPN, or cirrhosis, whole blood levels have been shown to correlate well with neuropsychological improvement, although whether the laboratory changes precede the CNS or merely track with them remains unclear. It is recommended that both CNS functional testing and laboratory evaluation be used to monitor therapy of these patients. Long-term monitoring of Behcet disease has not been reported, and it is not known if the Mn levels respond to therapy.
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.
4.7-18.3 ng/mL
Interpretation
Provides information to assist in interpretation of the test results
Whole blood or serum concentrations in combination with brain magnetic resonance imaging scans and neurological assessment may be used to detect excessive exposure. Values between 1 and 2 times the upper limit of normal may be due to differences in hematocrit and normal biological variation and should be interpreted with caution before concluding that hypermanganesemia is contributing to the disease process. Values greater than twice the upper limit of normal correlate with disease. For longitudinal monitoring, sampling no more frequently than the half-life of the element (40 days) should be used.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Whole blood manganese (Mn) concentrations are not responsive to dietary depletion, but measures of serum Mn are potentially useful.
Contamination of the collection site and of the specimen must be avoided. In the case of environmental evaluation, do not collect specimens in the workplace. Failure to use metal-free collection procedures and devices may cause falsely increased results. See Specimen Required and Metals Analysis Specimen Collection and Transport for collection and processing information.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Levy BS, Nassetta WJ. Neurologic effects of manganese in humans: A review. Int J Occup Environ Health. 2003;9(2):153-163. doi:10.1179/oeh.2003.9.2.153
2. Choi Y, Park JK, Park NH, et al. Whole blood and red blood cell manganese reflected signal intensities of T1-weighted magnetic resonance images better than plasma manganese in liver cirrhotics. J Occup Health. 2005;47(1):68-73. doi:10.1539/joh.47.68
3. Sanotsky Y, Lesyk R, Fedoryshyn L, Komnatska I, Matviyenko Y, Fahn S. Manganic encephalopathy due to "ephedrone" abuse. Mov Disord. 2007;22(9):1337-1343. doi:10.1002/mds.21378
4. Jiang Y, Zheng W, Long L, et al. Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: search for biomarkers of manganese exposure. Neurotoxicology. 2007;28(1):126-135. doi:10.1016/j.neuro.2006.08.005
5. Guilarte TR, Chen MK, McGlothan JL, et al. Nigrostriatal dopamine system dysfunction and subtle motor deficits in manganese-exposed non-human primates. Exp Neurol. 2006;202(2):381-390. doi:10.1016/j.expneurol.2006.06.015
6. Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds: Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023
7. O'Neal SL, Zheng W. Manganese toxicity upon overexposure: a decade in review. Curr Environ Health Rep. 2015;2(3):315-328. doi:10.1007/s40572-015-0056-x
Method Description
Describes how the test is performed and provides a method-specific reference
The metal of interest is analyzed by triple-quadrupole 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
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.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
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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.
CPT codes are provided by the performing laboratory.
83785
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 |
|---|---|---|
| MNB | Manganese, B | 5681-2 |
| 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.
|
|---|---|---|
| 89120 | Manganese, B | 5681-2 |