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Test Code MISC2MAYOGDS Gadolinium, Serum

Reporting Name

Gadolinium, S

Useful For

Aiding in documenting past exposure to gadolinium-based contrast agents in serum specimens

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum


Specimen Required


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.

Supplies: Metal Free Specimen Vial (T173)

Collection Container/Tube:  Plain, royal blue-top Vacutainer plastic trace element blood collection tube

Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial

Specimen Volume: 0.8 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, screw-capped 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 for complete instructions.


Specimen Minimum Volume

0.2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days METAL FREE
  Ambient  14 days METAL FREE
  Frozen  14 days METAL FREE

Reference Values

<0.5 ng/mL

Day(s) Performed

Wednesday

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 US 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 (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.

 

Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with kidney insufficiency. Patients with reduced kidney function and some patients with normal kidney function may exhibit a prolonged gadolinium elimination half-life.

 

To date the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and often in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe kidney disease, and almost all have been associated with prior use of GBCA. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.

Interpretation

Elevated gadolinium observed in serum specimens drawn more than 96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal kidney function and may indicate prolonged elimination of gadolinium and exposure to anthropogenic sources.

Method Description

Gadolinium in serum and urine is analyzed by inductively coupled plasma-mass spectrometry  in standard mode using terbium  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; Rifai N, Horwath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018)

Report Available

2 to 8 days

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Forms

If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.