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Test Code GDS Gadolinium, Serum

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Gadolinium, S

Specimen Type

Serum


Specimen Required


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 Mayo metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Do not insert a pipette 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.


Reject Due To

Hemolysis

Mild OK; Gross OK

Lipemia

Mild OK; Gross OK

Icterus

Mild OK; Gross reject

Other

NA

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 14 days
  Ambient  14 days
  Frozen  14 days

Specimen Minimum Volume

0.4 mL

Day(s) and Time(s) Performed

Thursday; 8 a.m.

Specimen Retention Time

14 days

Analytic Time

1 day

Reference Values

<0.5 ng/mL

Useful For

An aid in documenting past exposure to gadolinium-containing chelates

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Test Classification

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 U.S. Food and Drug Administration.

CPT Code Information

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GDS Gadolinium, S 80912-9

 

Result ID Test Result Name Result LOINC Value
29251 Gadolinium, S 80912-9

Clinical Information

Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media for magnetic resonance imaging and computer tomography scanning.

                      

Gadolinium is eliminated primarily by the renal filtration. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes. Patients with reduced renal function exhibit an increased gadolinium excretion half-life.

 

Gadolinium has been associated with the nephrogenic systemic fibrosis in patients with impaired renal function. In this syndrome, prolonged retention of gadolinium is thought to allow the gadolinium cation to dissociate from its synthetic organic chelator and deposit predominantly in the skin, although other organs may be affected as well. These patients are often severely debilitated by progressive skin thickening and tightening. Fibrosis of skeletal muscle, lungs, liver, testes, and myocardium have also been observed, often with fatal results. Because the ionic radius of gadolinium (3+) is similar to that of calcium (2+), it may also deposit in bone.

 

Three hemodialysis treatments are required to substantially remove gadolinium from patients with impaired renal function; peritoneal dialysis is not effective.

Interpretation

Elevated gadolinium (>3 ng/mL) observed in serum specimens draw >96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal renal function, indicating impaired elimination of gadolinium or exposure to anthropogenic sources. Patients with reduced renal function who have been exposed to gadolinium may have an increased risk to develop nephrogenic systemic fibrosis.

           

A normal value is <0.5 ng/mL; the lower limit of the assay's reportable range is 0.1 ng/mL.

Cautions

Serum gadolinium concentration may be elevated if the specimen is drawn <96 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated serum gadolinium in a specimen drawn <96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.

Clinical Reference

1. Othersen JB, Maize JC, Woolson RF, Budisavljevic MN: Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;22:3179-3185

2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J Am Soc Nephrol 2007;2:200-202

3. Leung N, Pittelkow M, Lee CU, et al: Chelation of gadolinium with deferoxamine in a patient with nephrogenic systemic fibrosis. NDT Plus 2009;2:309-311

4. Christensen KN, Lee CU, Hanley MM, et al: Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermat 2011;64(1):91-96

5. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106

6. Telgmann L, Sperling M, Karst U: Determination of gadolinium-based MRI contrast agents in biological and environmental samples: A review. Analytica Chimica Acta 2013;764:1-16

Method Description

Gadolinium (Gd) in serum and urine is analyzed by ICP-MS in standard mode using terbium (Tb) as an internal standard and a plasma matrix calibration.

(Leung N, Pittelkow MR, Lee CU et al: Chelation of gadolinium with deferoxamine in a patient with nephrogenic systemic fibrosis. NDT Plus 2009;2[4]:309-311)

 

Supportive Data

An evaluation of serum gadolinium concentration in healthy human subjects with no exposure to gadolinium chelates within 96 hours of serum collection generated a reference range of <0.1 to 0.5 ng/mL (median value 0.2 ng/mL) with no evidence of age or gender trend. A small number of patients studied at Mayo Clinic have demonstrated measureable (0.6-2.1 ng/mL) gadolinium in serum collected 30 days after gadolinium infusion, so some delay in total elimination is possible. Serum gadolinium concentrations observed in Mayo Clinic patients with nephrogenic systemic fibrosis were in the range of 2 to 5 ng/mL. 95% of unexposed patients have values <0.1 ng/mL more than 96 hours after infusion. The lower limit of detection is 0.1 ng/mL.