Test Catalog

Test Id : CRS

Chromium, Serum

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

Screening for occupational exposure

 

Monitoring metallic prosthetic implant wear

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

Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectometry (DRC-ICP-MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

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

Chromium, S

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

Chromium (Cr)

Cr (Chromium)

Specimen Type
Describes the specimen type validated for testing

Serum

Ordering Guidance

COWB / Cobalt, Blood is the FDA recommended test for monitoring cobalt in metal-on-metal implant patients.

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 interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Supplies:

-Metal Free B-D Tube (No Additive), 6 mL (T184)

-Metal Free Specimen Vial (T173)

Collection Container/Tube: Plain, royal blue-top Vacutainer plastic trace element blood collection tube (T184)

Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial (T173)

Specimen Volume: 1.6 mL

Collection Instructions:

1. Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.

2. Remove the stopper. Carefully pour specimen into a Mayo metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Do not insert a pipet into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.

3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: If ordering the trace element blood collection tube from BD, order catalog #368380.

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

0.4 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
Serum Refrigerated (preferred) 28 days METAL FREE
Ambient 28 days METAL FREE
Frozen 28 days METAL FREE

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

Screening for occupational exposure

 

Monitoring metallic prosthetic implant wear

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

Chromium (Cr) exists in valence states ranging from 2(-) to 6(+). Hexavalent chromium (Cr[+6]) and trivalent chromium (Cr[+3]) are the 2 most prevalent forms. Cr(+6) is used in industry to make chromium alloys including stainless steel, pigments, and electroplated coatings. Cr(+6), a known carcinogen, is immediately converted to Cr(+3) upon exposure to biological tissues. Cr(+3) is the only chromium species found in biological specimens.

 

Serum 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.

<0.3 ng/mL

When collected by a phlebotomist experienced in ultra-clean collection technique and handled according to the instructions in Trace Metals Analysis Specimen Collection and Transport in Special Instructions, we have observed the concentration of chromium in serum to be <0.3 ng/mL. However, the majority of specimens submitted for analysis from unexposed individuals contain 0.3 ng/mL to 0.9 ng/mL of chromium. Commercial evacuated blood collection tubes not designed for trace-metal specimen collection yield serum containing 2.0 ng/mL to 5.0 ng/mL chromium derived from the collection tube.

Interpretation
Provides information to assist in interpretation of the test results

Results greater than the flagged value indicate clinically significant exposure to chromium (Cr) (see Cautions about specimen collection). The reported units of measurement for chromium of ng/mL is equivalent to mcg/L.

 

Prosthesis wear is known to result in an increased circulating concentration of metal ions. A modest increase (0.3-0.6 ng/mL) in serum Cr concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 1 ng/mL in a patient with a Cr-based implant suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure. However, the FDA recommends testing chromium in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.

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

Specimens from unexposed individuals collected using metal-free collection procedures typically have chromium above 0.3 ng/mL. Chromium is present in our environment at 100-fold to 1,000-fold higher concentration than found in biological tissues. Reports of increased serum chromium could be due to external contamination. Metal-free serum collection procedures must be followed, and centrifuged serum must be aliquoted into a Mayo Clinic Laboratories metal-free vial to avoid external contamination. Specimens collected using an anticoagulant are unacceptable; trace amounts of chromium are present in anticoagulants used in evacuated collection tubes.

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. NIOSH Hexavalent Chromium Criteria Document Update. September 2008; Available at www.cdc.gov/niosh/topics/hexchrom/

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;92:1-5

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

Chromium (Cr) in serum is analyzed by inductively coupled plasma-mass spectometry (ICP-MS) in dynamic reaction cell (DRC) mode using rhodium (Rh) as an internal standard 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.

Monday, Wednesday, Friday

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.

1 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

7 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.

82495

LOINC® Information

Test Id Test Order Name Order LOINC Value
CRS Chromium, S 5622-6
Result Id Test Result Name Result LOINC Value
Result LOINC Value Tooltip
8638 Chromium, S 5622-6

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