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 |
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
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)
Source: Head, beard, mustache, chest, pubic
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.
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.
0.05 g
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
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) | ||
| Refrigerated | |||
| Frozen | |||
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(1):81-90
2. Pearce 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(12):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. Regul Toxicol Pharmacol. 2007;49(1):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(2):302-306
5. Barbosa F Jr, Tanus-Santos JE, Gerlach RF, Parsons PJ. A critical review of biomarkers used for monitoring human exposure to lead: advantages, limitations, and future needs. Environ Health Perspect. 2005;113(12):1669-1674
6. DiPietro ES, Phillips DL, Paschal DC, Neese JW. Determination of trace elements in human hair. Reference intervals for 28 elements in nonoccupationally exposed adults in the US and effects of hair treatments. Biol Trace Elem Res. 1989;22(1):83-100
7. Strathmann FG, Blum LM. Toxic elements. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:chap 44
Method Description
Describes how the test is performed and provides a method-specific reference
The metal analytes of interest are 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.
Wednesday
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 :
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.
CPT codes are provided by the performing laboratory.
82175
83655
83825
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 |