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22220 Aluminum, Serum (AL)

Aluminum, Serum (AL)
Test Code: ALUM
Synonyms/Keywords
Al (Aluminum), Serum
Useful For
​Preferred monitoring for aluminum toxicity in patients undergoing dialysis
 
Preferred test for routine aluminum screening 
 
Monitoring metallic prosthetic implant wear
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum Greiner Z Trace Element no-additive (Aluminum Only)​, 6 mL (T713) 1.2 mL​ 0.3 mL​
Collection Processing Instructions

​See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.

Trace Metals Analysis Specimen Collection and Transport

Submit specimen in 7-mL Mayo metal-free, screw-capped, polypropylene vial (T173).

Special tubes are available in Main Marshfield Labs Specimen Processing.


Additional Information: High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerated (preferred)​ 7 days​
Ambient ​ 7 days​
Frozen ​ 7 days​
Interference

Failure to pay attention to proper specimen collection procedures can cause abnormal results due to specimen contamination, which can lead to misinterpretation and misdiagnosis:

-Special evacuated blood collection tubes are required for aluminum testing.(4) These tubes are readily available (Mayo Clinic Laboratories T713) and should always be used.

-Most of the common evacuated blood collection devices have rubber stoppers that are comprised of aluminum-silicate. Simple puncture of the rubber stopper for blood collection is sufficient to contaminate the specimen with aluminum. Typically, blood drawn in standard evacuated blood tubes will be contaminated by 20 to 60 ng/mL aluminum.

-The use of wooden applicator sticks or pipette tips during specimen aliquoting can cause abnormal results due to contamination.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Tuesday, Thursday
1 to 7 days​
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS) ​
Reference Lab
Reference Range Information
< 7 ng/mL
Interpretation

Patients in renal failure not receiving dialysis therapy invariably have serum aluminum levels above the 60 ng/mL range.

McCarthy(1) and Hernandez(2) describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:

-Patients in renal failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum below 20 ng/mL and parathyroid hormone (PTH) concentrations above 150 pg/mL, which is typical of secondary hyperparathyroidism.

-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum above 60 ng/mL and PTH concentrations below 50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).

-Patients who had serum aluminum above 60 ng/mL and below 100 ng/mL were identified as candidates for later onset of aluminum-overload disease that required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had less than 10 ng/mL of aluminum, and ensuring the albumin used during postdialysis therapy was aluminum free.

Prosthesis wear is known to result in increased circulating concentration of metal ions.(3) Modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​82108
Synonyms/Keywords
Al (Aluminum), Serum
Ordering Applications
Ordering Application Description
​Centricity ​Aluminum, Serum (AL)
​Cerner ​Aluminum Level (8373)
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum Greiner Z Trace Element no-additive (Aluminum Only)​, 6 mL (T713) 1.2 mL​ 0.3 mL​
Collection Processing

​See Metals Analysis-Collection and Transport in Special Instructions for complete instructions.

Trace Metals Analysis Specimen Collection and Transport

Submit specimen in 7-mL Mayo metal-free, screw-capped, polypropylene vial (T173).

Special tubes are available in Main Marshfield Labs Specimen Processing.


Additional Information: High concentrations of gadolinium and iodine are known to interfere with most metals tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ Refrigerated (preferred)​ 7 days​
Ambient ​ 7 days​
Frozen ​ 7 days​
Interference

Failure to pay attention to proper specimen collection procedures can cause abnormal results due to specimen contamination, which can lead to misinterpretation and misdiagnosis:

-Special evacuated blood collection tubes are required for aluminum testing.(4) These tubes are readily available (Mayo Clinic Laboratories T713) and should always be used.

-Most of the common evacuated blood collection devices have rubber stoppers that are comprised of aluminum-silicate. Simple puncture of the rubber stopper for blood collection is sufficient to contaminate the specimen with aluminum. Typically, blood drawn in standard evacuated blood tubes will be contaminated by 20 to 60 ng/mL aluminum.

-The use of wooden applicator sticks or pipette tips during specimen aliquoting can cause abnormal results due to contamination.

Useful For
​Preferred monitoring for aluminum toxicity in patients undergoing dialysis
 
Preferred test for routine aluminum screening 
 
Monitoring metallic prosthetic implant wear
Reference Range Information
< 7 ng/mL
Interpretation

Patients in renal failure not receiving dialysis therapy invariably have serum aluminum levels above the 60 ng/mL range.

McCarthy(1) and Hernandez(2) describe a biochemical profile that is characteristic of aluminum overload disease in dialysis patients:

-Patients in renal failure with no signs or symptoms of osteomalacia or encephalopathy usually had serum aluminum below 20 ng/mL and parathyroid hormone (PTH) concentrations above 150 pg/mL, which is typical of secondary hyperparathyroidism.

-Patients with signs and symptoms of osteomalacia or encephalopathy had serum aluminum above 60 ng/mL and PTH concentrations below 50 pg/mL (PTH above the reference range, but low for secondary hyperparathyroidism).

-Patients who had serum aluminum above 60 ng/mL and below 100 ng/mL were identified as candidates for later onset of aluminum-overload disease that required aggressive efforts to reduce their daily aluminum exposure. This was done by switching them from aluminum-containing phosphate binders to calcium-containing phosphate binders, by ensuring that their dialysis water had less than 10 ng/mL of aluminum, and ensuring the albumin used during postdialysis therapy was aluminum free.

Prosthesis wear is known to result in increased circulating concentration of metal ions.(3) Modest increase (6-10 ng/mL) in serum aluminum concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations above 10 ng/mL in a patient with an aluminum-based implant not undergoing dialysis suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Tuesday, Thursday
1 to 7 days​
Dynamic Reaction Cell-Inductively Coupled Plasma-Mass Spectrometry (DRC-ICP-MS) ​
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​82108
For most current information refer to the Marshfield Laboratory online reference manual.