Aluminum, Serum (AL)

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Test Code: ALUM

Overview
Ordering
Specimen
Performing
Clinical/Interpretive
Contacts
Coding

Synonyms/Keywords

Al (Aluminum), Serum

Useful For

Preferred monitoring for aluminum toxicity in patients undergoing dialysis

Preferred test for routine aluminum screening

Monitoring metallic prosthetic implant wear

Specimen Requirements

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Serum	Royal Blue Metal Free B-D Tube (No Additive) (T184)	Greiner Z trace Element Metal Free Specimen Vial (T713)	1.2 mL	0.3 mL

Collection Processing Instructions

See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.

Trace Metals Analysis Specimen Collection and Transport

Submit specimen in 6 mL Royal Blue (BD) top tube (T184).

Special tubes are available in Main Marshfield Labs Specimen Processing.

Additional Information: 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.

Specimen Stability Information

Specimen Type	Temperature	Time
Serum	Refrigerated (preferred)	7 days
	Ambient	7 days
	Frozen	7 days

Interference

Failure to pay attention to proper specimen collection procedures can cause abnormal results due to specimen contamination, which can lead to misinterpretation and misdiagnosis:

-Special evacuated blood collection tubes are required for aluminum testing. These tubes are readily available (Mayo Clinic Laboratories T713) and should always be used.

-Most of the common evacuated blood collection devices have rubber stoppers that are comprised of aluminum-silicate. Simple puncture of the rubber stopper for blood collection is sufficient to contaminate the specimen with aluminum. Typically, blood drawn in standard evacuated blood tubes will be contaminated by 20 to 60 ng/mL aluminum.

-The use of wooden applicator sticks or pipette tips during specimen aliquoting can cause abnormal results due to contamination.

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Analytical Time	Methodology/Instrumentation
Mayo Clinic Laboratories	Tuesday, Thursday	1 to 7 days	Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS)

Reference Lab

Mayo Clinic Laboratories

Reference Range Information

< 7 ng/mL

< 60 ng/mL (dialysis patients)

Interpretation

Patients in renal failure not receiving dialysis therapy invariably have serum aluminum levels above the 60 ng/mL range.

McCarthy and Hernandez describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:

-Patients in renal failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum below 20 ng/mL and parathyroid hormone (PTH) concentrations above 150 pg/mL, which is typical of secondary hyperparathyroidism.

-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum above 60 ng/mL and PTH concentrations below 50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).

-Patients who had serum aluminum above 60 ng/mL and below 100 ng/mL were identified as candidates for later onset of aluminum-overload disease that required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had less than 10 ng/mL of aluminum, and ensuring the albumin used during postdialysis therapy was aluminum free.

Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

Outreach CPTs

CPT	Modifier (if needed)	Quantity	Description	Comments
82108