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24949 Cobalt, Serum (COS)

Cobalt, Serum (COS)
Test Code: COBALSO
Synonyms/Keywords
Co (Cobalt), Cobalt (Co)
Useful For

Detecting cobalt toxicity

Monitoring metallic prosthetic implant wear

This test is not useful for assessment of 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)
Serum​ Plain, Royal Blue Top (RBTT) No Additive vacutainer​ ​ 1.6 mL​ ​0.4 mL ​
Collection Processing 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 a 7-mL Mayo metal-free, screw-capped, polypropylene vial, (Call Marshfield Labs Customer Service at ext. 16700 to obtain this supply) 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 Metals Analysis-Collection and Transport in Special Instructions for complete instructions.
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)​ ​28 days
​Ambient ​28 days
​Frozen ​28 days
Interference

Because this test uses mass spectrometry detection, the radioactive form of cobalt, (60)Co, is not quantified.

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 serum 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, Friday ​ 1 to 5 days​
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
​
Reference Lab
Mayo Clinic Laboratories
Reference Range Information
Performing Location Reference Range
Mayo Clinic Laboratories​​

<1.0 ng/mL

<10.0 ng/mL (Metal-on-metal implant)

Reference values apply to all ages.

The reported unit of measurement for cobalt of ng/mL is equivalent to mcg/L.

Interpretation
Concentrations > or =1.0 ng/mL indicate possible environmental or occupational exposure. Cobalt concentrations associated with toxicity must be interpreted in the context of the source of exposure.  If cobalt is ingested, concentrations > 5 ng/mL suggest major exposure and likely toxicity.  If cobalt exposure is due to orthopedic implant wear, there are no large case number reports associating high circulating serum cobalt with toxicity.
 
There are no Occupational Health and Safety Administration (OSHA) blood or urine criteria for occupational exposure to cobalt.
 
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (4-10 ng/mL) in serum cobalt concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations >10 ng/mL in a patient with cobalt-based implant suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.  However, the FDA recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants. 
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83018 ​ ​ ​ ​
Synonyms/Keywords
Co (Cobalt), Cobalt (Co)
Ordering Applications
Ordering Application Description
​Centricity ​Cobalt, Serum
​Cerner ​Cobalt, Serum (80084)
​COM ​Cobalt, Serum
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​ Plain, Royal Blue Top (RBTT) No Additive vacutainer​ ​ 1.6 mL​ ​0.4 mL ​
Collection Processing
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 a 7-mL Mayo metal-free, screw-capped, polypropylene vial, (Call Marshfield Labs Customer Service at ext. 16700 to obtain this supply) 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 Metals Analysis-Collection and Transport in Special Instructions for complete instructions.
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)​ ​28 days
​Ambient ​28 days
​Frozen ​28 days
Interference

Because this test uses mass spectrometry detection, the radioactive form of cobalt, (60)Co, is not quantified.

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 serum cobalt results may be an incidental and misleading finding.

Useful For

Detecting cobalt toxicity

Monitoring metallic prosthetic implant wear

This test is not useful for assessment of vitamin B12 activity.

Reference Range Information
Performing Location Reference Range
Mayo Clinic Laboratories​​

<1.0 ng/mL

<10.0 ng/mL (Metal-on-metal implant)

Reference values apply to all ages.

The reported unit of measurement for cobalt of ng/mL is equivalent to mcg/L.

Interpretation
Concentrations > or =1.0 ng/mL indicate possible environmental or occupational exposure. Cobalt concentrations associated with toxicity must be interpreted in the context of the source of exposure.  If cobalt is ingested, concentrations > 5 ng/mL suggest major exposure and likely toxicity.  If cobalt exposure is due to orthopedic implant wear, there are no large case number reports associating high circulating serum cobalt with toxicity.
 
There are no Occupational Health and Safety Administration (OSHA) blood or urine criteria for occupational exposure to cobalt.
 
Prosthesis wear is known to result in increased circulating concentration of metal ions. Modest increase (4-10 ng/mL) in serum cobalt concentration is likely to be associated with a prosthetic device in good condition. Serum concentrations >10 ng/mL in a patient with cobalt-based implant suggest significant prosthesis wear. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure.  However, the FDA recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants. 
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
Mayo Clinic Laboratories​​ Monday, Wednesday, Friday ​ 1 to 5 days​
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)
​
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​83018 ​ ​ ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.