| A B C D E F G H I J K L M N O P Q R S T U V W X Y Z # |
Cobalt, Serum
Test CodeCOBLT
Alias/See Also
Epic: LAB1020
Mayo: COS
Co (Cobalt)
Mayo: COS
Co (Cobalt)
CPT Codes
83018
Preferred Specimen
Specimen Type: Serum
Collection Container: Plain, royal blue-top Vacutainer plastic trace element blood collection tube
Specimen Volume: 1.6 mL
Patient Preparation
High concentrations of gadolinium and iodine are known to interfere with most metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
Minimum Volume
0.4 mL
Instructions
- Allow the specimen to clot for 30 minutes; then centrifuge the specimen to separate serum from the cellular fraction.
- 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.
- See Metals Analysis Specimen Collection and Transport for complete instructions.
Transport Container
Metal-free, screw-capped plastic vial
Specimen Stability
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | METAL FREE |
| Ambient | 28 days | METAL FREE | |
| Frozen | 28 days | METAL FREE |
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Methodology
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
Setup Schedule
Tuesday, Wednesday, Friday
Report Available
1 to 4 days
Limitations
CAUTIONS
Because this test uses mass spectrometry detection, the radioactive form of cobalt, (60)Co, is not quantified.
Specimen collection procedures for cobalt require special specimen collection tubes, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless these precautions are taken, elevated serum cobalt results may be an incidental and misleading finding.
Because this test uses mass spectrometry detection, the radioactive form of cobalt, (60)Co, is not quantified.
Specimen collection procedures for cobalt require special specimen collection tubes, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless these precautions are taken, elevated serum cobalt results may be an incidental and misleading finding.
Reference Range
REFERENCE VALUES
<1.0 ng/mL
<10.0 ng/mL (Metal-on-metal implant)
Reference values apply to all ages.
The reported unit of measurement for cobalt of ng/mL is equivalent to mcg/L.
INTERPRETATION
<10.0 ng/mL (Metal-on-metal implant)
Reference values apply to all ages.
The reported unit of measurement for cobalt of ng/mL is equivalent to mcg/L.
INTERPRETATION
Concentrations greater than or equal to 1.0 ng/mL indicate possible environmental or occupational exposure. Cobalt concentrations associated with toxicity must be interpreted in the context of the source of exposure. If cobalt is ingested, concentrations greater than 5 ng/mL suggest major exposure and likely toxicity. If cobalt exposure is due to orthopedic implant wear, there are no large case number reports associating high circulating serum cobalt with toxicity.
There are no Occupational Health and Safety Administration blood or urine criteria for occupational exposure to cobalt.
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (4-10 ng/mL) in serum cobalt concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with cobalt-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 US Food and Drug Administration recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.
There are no Occupational Health and Safety Administration blood or urine criteria for occupational exposure to cobalt.
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (4-10 ng/mL) in serum cobalt concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with cobalt-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 US Food and Drug Administration recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.
Clinical Significance
USEFUL FOR
Detecting cobalt toxicity
Monitoring metallic prosthetic implant wear
This test is not useful for assessment of vitamin B12 activity.
Monitoring metallic prosthetic implant wear
This test is not useful for assessment of vitamin B12 activity.
CLINICAL INFORMATION
Cobalt is rare but widely distributed in the environment, used in the manufacture of hard alloys with high melting points and resistance to oxidation; cobalt alloys are used in manufacture of some artificial joint prosthesis devices. Cobalt salts are used in the glass and pigment industry. Previously, cobalt salts were sometimes used as foam stabilizers in the brewing industry; this practice was banned due to the cardiovascular diseases it induced. The radioactive isotope of cobalt, (60)Co, is used as a gamma emitter in experimental biology, cancer therapy, and industrial radiography.
Cobalt is an essential cofactor in vitamin B12 metabolism. Cobalt deficiency has not been reported in humans.
Cobalt is not highly toxic, but large doses will produce adverse clinical manifestations. Acute symptoms are pulmonary edema, allergy, nausea, vomiting, hemorrhage, and kidney failure. Chronic symptoms include pulmonary syndrome, skin disorders, and thyroid abnormalities. The inhalation of dust during machining of cobalt alloyed metals can lead to interstitial lung disease.
Serum cobalt concentrations are likely to be increased above the reference range in patients with joint prosthesis containing cobalt. Prosthetic devices produced by DePuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside are typically 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.
Cobalt is an essential cofactor in vitamin B12 metabolism. Cobalt deficiency has not been reported in humans.
Cobalt is not highly toxic, but large doses will produce adverse clinical manifestations. Acute symptoms are pulmonary edema, allergy, nausea, vomiting, hemorrhage, and kidney failure. Chronic symptoms include pulmonary syndrome, skin disorders, and thyroid abnormalities. The inhalation of dust during machining of cobalt alloyed metals can lead to interstitial lung disease.
Serum cobalt concentrations are likely to be increased above the reference range in patients with joint prosthesis containing cobalt. Prosthetic devices produced by DePuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside are typically 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.
Performing Laboratory
Mayo Clinic Laboratories - Rochester
3050 Superior Drive NW
Rochester, MN 55901
Additional Information
Cobalt, Serum
Last Updated: July 11, 2023
Last Review: N. Wolford, July 11, 2023