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Test Code MNS Manganese, Serum

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

Manganese, S

Specimen Type

Serum


Specimen Required


Patient Preparation: High concentrations of gadolinium, iodine, and barium are known to interfere with most metals tests. If gadolinium-, iodine, or barium-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, and then centrifuge to separate serum from the cellular fraction. Serum must be removed from cellular fraction within 4 hours of draw. Avoid hemolysis.

2. Remove the stopper. Carefully pour specimen into a Mayo metal-free, polypropylene vial, while 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.


Reject Due To

Hemolysis

Mild reject; Gross reject

Lipemia

Mild OK; Gross OK

Icterus

Mild OK; Gross reject

Other

NA

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 28 days
  Ambient  28 days
  Frozen  28 days

Specimen Minimum Volume

0.4 mL

Day(s) and Time(s) Performed

Tuesday, Friday; 8 a.m.

Specimen Retention Time

7 days

Analytic Time

1 days

Reference Values

<2.4 ng/mL

Reference values have not been established for patients that are <18 years of age.

Useful For

Monitoring manganese exposure

 

Nutritional monitoring

 

Clinical trials

Method Name

Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-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

83785

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MNS Manganese, S 5683-8

 

Result ID Test Result Name Result LOINC Value
8413 Manganese, S 5683-8

Clinical Information

Manganese (Mn) is a trace essential element with many industrial uses. The twelfth most abundant element in the earth's crust, nearly all mined manganese is consumed in the production of ferromanganese, which is then used to remove oxygen and sulfur impurities from steel. These industrial processes cause elevated environmental exposures to airborne manganese dust and fumes, which in turn have led to well-documented cases of neurotoxicity among exposed workers. Mining and iron and steel production have been implicated as sources of exposure.

 

Inhalation is the primary source of entry for manganese toxicity. Signs of toxicity may appear quickly, and neurological symptoms are rarely reversible. Manganese toxicity is generally recognized to progress through 3 stages. Levy describes these stages. "The first stage is a prodrome of malaise, somnolence, apathy, emotional lability, sexual dysfunction, weakness, lethargy, anorexia, and headaches. If there is continued exposure, progression to a second stage may occur, with psychological disturbances, including impaired memory and judgement, anxiety, and sometimes psychotic manifestations such as hallucinations. The third stage consists of progressive bradykinesia, dysarthrian axial and extremity dystonia, paresis, gait disturbances, cogwheel rigidity, intention tremor, impaired coordination, and a mask-like face. Many of those affected may be permanently and completely disabled."(1) Few cases of manganese deficiency or toxicity due to ingestion have been documented. Only 1% to 3% manganese is absorbed via ingestion, while most of the remaining manganese is excreted in the feces.

 

As listed in the United States National Agriculture Library, manganese adequate intake is 1.6 mg/day to 2.3 mg/day for adults. This level of intake is easily achieved without supplementation by a diverse diet including fruits and vegetables, which have higher amounts of manganese than other food types. Patients on a long-term parenteral nutrition should receive manganese supplementation and should be monitored to ensure that circulatory levels of manganese are appropriate.

Interpretation

Serum manganese results above the reference values suggest recent exposure.

Cautions

Specimens collected from healthy, unexposed adults have extremely low levels of manganese. Because of the high environmental concentration of manganese, contamination is always a possibility when considering elevated results. Precautions must be taken to ensure the specimen is not contaminated. Metal-free serum collection procedures must be followed and centrifuged serum must be aliquoted into an acid-washed Mayo metal-free vial.

Clinical Reference

1. Levy BS, Nassetta WJ: Neurologic effects of Manganese in humans: A review. Int J Occup Environ Health Apr/Jun 2003;9(2):153-163

2. Chiswell B, Johnson D: Manganese: In Handbook on Metals in Clinical and Analytical Chemistry. Edited by HG Sigel, H Sigel. Marcel Dekker, Inc, New York, 1994, pp 479-494

3. Finley J, Davis C: Manganese deficiency and toxicity: Are high or low dietary amounts of manganese cause for concern? Biofactors 1999;10:15-24

Method Description

Manganese in serum is analyzed by inductively coupled plasma-mass spectrometry in dynamic reaction cell mode using gallium as an internal standard and a salt matrix calibration.(Unpublished Mayo method)