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HelpTest Code LAB1020 Cobalt, Serum
Additional Codes
COS
Useful For
Detecting cobalt toxicity
Monitoring metallic prosthetic implant wear
This test is not useful for assessment of vitamin B12 activity.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
The US Food and Drug Administration recommended test for monitoring cobalt in patients with metal-on-metal implants is COWB / Cobalt, Blood.
This test should not be ordered to assess vitamin B12 activity. For that assessment see B12 / Vitamin B12 Assay, Serum or ACASM / Pernicious Anemia Cascade, 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: 0.5 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 a Mayo metal-free, polypropylene vial, 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 Specimen Collection and Transport for complete instructions.
Specimen Minimum Volume
0.3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 28 days | METAL FREE |
| Ambient | 28 days | METAL FREE | |
| Frozen | 28 days | METAL FREE |
Special Instructions
Reference Values
<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.
Day(s) Performed
CPT Code Information
83018
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| COS | Cobalt, S | 5627-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 80084 | Cobalt, S | 5627-5 |
Interpretation
Concentrations greater than or equal to 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 greater than 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 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 above 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 US Food and Drug Administration recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.
Method Description
The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)
Report Available
1 to 4 daysSpecimen Retention Time
14 daysReject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Method Name
Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)