Cobalt, Urine (COU)

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Cobalt, Urine (COU)

Test Code: COBURSO

Overview
Ordering
Specimen
Performing
Clinical/Interpretive
Contacts
Coding

Synonyms/Keywords

Co (Cobalt)

Cobalt (Co)

U COBURSO

Useful For

Detecting cobalt exposure

Monitoring metallic prosthetic implant wear

This test is not useful to assess vitamin B12 activity

Specimen Requirements

Specimen Type	Preferred Container/Tube	Acceptable Container/Tube	Specimen Volume	Specimen Minimum Volume (allows for 1 repeat)	Pediatric Minimum Volume (no repeat)
Urine	Plastic, 10-mL urine tube or clean, plastic aliquot container with no metal cap or glued insert. NO Preservative		10 mL	0.4 mL

Collection Processing Instructions

24-Hour volume is required

1. Collect urine for 24 hours.

2. No preservative.

3. Metal-free urine collection procedures must be followed.
4. Refrigerate specimen within 4 hours of completion of 24-hour collection.

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
Urine	Refrigerated (preferred)	28 days
	Ambient	28 days
	Frozen	28 days

Rejection Criteria

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Interference

Specimen collection procedures for cobalt require special specimen collection tubes, rigorous attention to ultraclean specimen collection and handling procedures, and analysis in an ultraclean facility. Unless all of these precautions are taken, elevated urine cobalt results may be an incidental and misleading finding.

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Report Available	Methodology/Instrumentation
Mayo Clinic Laboratories	Monday, Wednesday and Friday	1 to 3 days	Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Reference Lab

Mayo Clinic Laboratories

Reference Range Information

Performing Location	Reference Range
Mayo Clinic Laboratories	0 - 17 years: not established >/= 18 years: 0.2 - 3.5 mcg/24h

Interpretation

Concentrations > or =2.0 mcg/specimen indicate excess exposure. There are no Occupational Safety and Health Administration (OSHA) blood or urine criteria for occupational exposure to cobalt.

Prosthesis wear is known to result in increased circulating concentration of metal ions. In a patient with a cobalt-based implant, modest increase (2-4 mcg/specimen) in urine cobalt concentration is likely to be associated with a prosthetic device in good condition. Excessive exposure is indicated when urine cobalt concentration is >5 mcg/specimen, consistent with prosthesis wear. Urine concentrations >20 mcg/specimen in a patient with a cobalt-based implant suggest significant prosthesis wear. Increased urine 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
83018		1	Heavy metal quantitative, each, not elsewhere specified