Test Catalog

Test Id : HMHA

Heavy Metals, Hair

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

Detection of nonacute arsenic, mercury, and lead exposure using hair specimens

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
ASHA Arsenic, Hair Yes Yes
PBHA Lead, Hair Yes Yes
HGHAR Mercury, Hair 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, Hair

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

Hair

Necessary Information

Indicate source of hair (axillary, head, or pubic), if known

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
ASHSC Specimen Source
HGHSC Specimen Source
PBHSC Specimen Source

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

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
Hair 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 using hair specimens

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 hair is higher than in other tissues.

 

Arsenic binds to keratin at the time of exposure, "trapping" the arsenic in hair. Therefore, hair analysis for arsenic is not only used to document that an exposure occurred, but when it occurred. Hair collected from the nape of the neck can be used to document recent exposure. Axillary or pubic hairs are used to document long-term (6 months-1 year) exposure.

 

Mercury

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

 

Lead

Hair analysis for lead can be used to corroborate blood analysis or to document past lead exposure. If the hair is collected and segmented in a time sequence (based on length from root), the approximate time of exposure can be assessed.

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 hair

 

LEAD

<4.0 mcg/g of hair

Reference values apply to all ages.

 

MERCURY

0-15 years: not established

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

Interpretation
Provides information to assist in interpretation of the test results

Hair grows at a rate of approximately 0.5 inch/month. Hair keratin synthesized today will protrude through the skin in approximately 1 week. Thus, a hair specimen collected at the skin level represents exposure of 1 week ago, 1 inch distally from the skin represents exposure 2 months ago, etc.

 

ARSENIC

Hair arsenic levels above 1.00 mcg/g dry weight may indicate excessive exposure. It is normal for some arsenic to be present in hair, as everybody is exposed to trace amounts of arsenic from the normal diet.

 

The highest hair 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, hair contains less than 1 mcg/g of mercury; any amount more than this indicates that exposure to more than normal amounts of mercury may have occurred.

 

LEAD

Normal hair lead content is below 4.0 mcg/g. While hair lead content above 10.0 mcg/g may indicate significant lead exposure, hair is also subject to potential external contamination with environmental lead and contaminants in artificial hair treatments (eg, dyeing, bleaching, or permanents). Ultimately, the hair 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. Sthiannopkao S, Kim K-W, Cho KH, et al: Arsenic levels in human hair, Kandal Province, Cambodia: The influences of groundwater arsenic, consumption period, age and gender. Applied Geochemistry. 2010;25:81-90

2. Pearse DC, Dowling K, Gerson, AR, et al: Arsenic microdistribution and speciation in toenail clippings of children living in a historic gold mining area. Sci Total Environ. 2010;408:2590-2599

3. Marques RC, Dorea JG, Bastos WR, Malm O: Changes in children hair-Hg concentrations during the first 5 years: maternal, environmental and iatrogenic modifying factors. Reg Toxicol Pharmacol. 2007;49:17-24

4. Canuel R, de Grosbois SB, Atikesse L, et al: New evidence on variations of human body burden of methylmercury from fish consumption. Environ Health Perspect. 2006;114:302-306

5. 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

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

7. 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 hair 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 8 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

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
HMHA Heavy Metals, Hair 34667-6
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.
31896 Arsenic, Hair 5584-8
ASHSC Specimen Source 31208-2
31900 Mercury, Hair 5686-1
HGHSC Specimen Source 31208-2
31898 Lead, Hair 5673-9
PBHSC Specimen Source 31208-2

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 | 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