Trace Elements

Blood: TREL (list trace elements in prompt box.  If inadequate space or element not listed in prompt box, list all trace elements in chartable comments)
Urine: UTREL (list trace elements in prompt box.  If inadequate space or element not listed in prompt box, list all trace elements in chartable comments)
Hair or Tissue: MISCREFNON with prompt: TREL Hair or TREL Tissue (and add an order comment with the trace elements requested)

For blood Copper, Lead, Zinc, or urine Mercury, see individual test pages.

For trace elements testing ordered by Dr. Hoffman, order test mnemonic HOFF.

CLS Staff: If Heavy Metals requested, before ordering the test, contact the physician for the specific list of metals if they are not indicated on requisition.

Cannot be collected by Mobile Collection Service (MCS).


Blood:
1 x 10 mL dark green top GLASS sodium heparin tube with rubber stopper (available from CLS Referrals Department)

Wear non-powdered gloves throughout blood collection and cleanse the collection site using isopropyl alcohol only.

Urine:
80 mL aliquot of 24 hr or random urine in plastic Starplex container

24 hour urine is preferable to random. Urine container is kept in the refrigerator during collection.  Collect away from suspected exposure site.  If workplace exposure suspected, collect during off-hours, away from work environment. 

Blood:
Centrifuge within 1 hour of collection:
1. Mix tube thoroughly and centrifuge.
2. Aliquot plasma using a plastic pipet (not glass) to a plastic screwcap Sardstedt2 aliquot tube (aliquot tubes available from Referrals).  Screw the caps on tightly to avoid leakage.
3. Discard middle layer (residual plasma and approximately 1/8 inch of the upper RBC layer) using the same pipet.
4. Aliquot RBC using a new plastic pipet (NOT glass) to a plastic screwcap Sarstedt2 aliquot tube.  Screw the caps on tightly to avoid leakage.
5. Send both aliquots (RBC and plasma) to DSC (do not send original sodium heparin tube). 

PSC & RRL:
Transport to DSC on ice.  Send specimen in a separate bag with a photocopy of the requisition.

Extra-regional:
Freeze aliquots and transport to DSC on dry ice.

DSC:
Freeze specimens upon receipt in lab; ensure frozen specimens do not thaw.



Urine:
For 24 hr urine, measure total urine volume and aliquot. 

PSC & RRL:
Transport to DSC on ice.  Send specimen in a separate bag with a photocopy of the requisition.

Extra-regional:
Freeze aliquots and transport to DSC on dry ice.

DSC:
Freeze specimens upon receipt in lab; ensure frozen specimens do not thaw.

See table below for trace element availability on various specimens:

Element	Blood	Urine	Element	Blood	Urine
Aluminum	X	X 1	Molybdenum	X	X
Antimony	X	X	Nickel	X	X
Arsenic	X	X	Palladium	Hair only
Barium		X	Phosphorus	Hair only
Beryllium		X	Platinum		X
Bismuth		X	Selenium	X	X
Boron		X	Silicon	X	X
Cadmium	X	X 2	Silver	X	X
Cesium	X		Strontium		X
Chromium	X	X	Sulfur	X	X
Cobalt	X	X	Tellurium		X
Copper	see below*	X	Thallium	X	X
Germanium	Hair only		Tin		X
Iodine	X		Titanium	X	X
Lead	see below*	X	Uranium		X
Manganese	X	X	Vanadium	X	X
Mercury	X	see below*	Zinc	see below*	X

NOTES:
* For blood Copper, Lead, Zinc, or urine Mercury, see individual test pages.

1. Aluminum - avoid antacids containing aluminum, fruits, chocolate, juices, beer, coffee and teas for 24 hours prior to collecting sample.
2. Cadmium - collection of urine specimens through a catheter frequently results in elevated values, because rubber contains trace amounts of cadmium that are extracted as urine passes through the catheter.

If it is requested that the test be sent to a lab other than London Health, contact CLS Referrals at 403-770-3285.