what is the normal level of cobalt in the blood

However, many orthopedists believe that the same levels should be achieved in persons implanted with a well-functioning hip device. For each blood or urine sample, one analysis is performed on a 400 μl aliquot. Reason for revision: Pain, very high ions, acetabular malposition. The ALVAL features were rated as high (extensive loss of synovium, 3; large perivascular lymphocytic aggregates, 3; loss of normal arrangement with distal lymphocytic aggregates and thick acellular areas, 3). The MHRA (medicines and healthcare products regulatory agency) the statutory body that regulates resurfacing devices in the UK advocates the figure of 119 nmol/L cobalt (or 7 … Very small amounts are needed for animals and humans to stay healthy. The Medical Products and Healthcare Devices Regulatory Agency in the UK recommends following MoM implantees at least annually for 5 years postsurgery and measuring Co and Cr in blood as well as performing imaging studies for patients who report painful hip replacements. The gritty, discolored synovial fluid around the joint was enzymatically digested then ultracentrifuged on a density gradient without filtering and the particles were isolated using the method of Billi et al. However, BD does not guarantee maximal contamination concentrations of Co or Cr. Two weeks after surgery, the patient's Co level decreased to 27.2 ppb. Significant relationships existed between the serum metal ion levels and the measured linear wear; the correlation coefficient for serum chromium was 0.915 (p < 0.001) and that for cobalt was 0.913 (p < 0.001). Joshua P. Gray, ... Sidhartha D. Ray, in Side Effects of Drugs Annual, 2018. Alteration is also found in normal B12 levels by age. Toxicity may occur in select industrial environments. Over time, upon removal of both MoM apparatuses, his hip pain improved, he recovered cardiac function (LVEF: 25%–35%), and his cobalt level decreased to 1.5 ppb. How Much Cobalt Is Normal? It is a very small part of our environment. 9 ng/ml. The implants also showed signs of wear. Three serum samples were divided and tested for Cr and Co ions in the trace element lab at Rush University, Chicago. Note the lack of metallosis. Cobalt is not an accumulating metal, meaning it is stored in the liver and processed out of the body through urine but not stored in the bones. His serum Co level was 156 ppb and he had a negative cardiac tissue biopsy for cobalt. The use of metal-on-metal (MoM) joint implants has caused toxic serum levels of chromium (Cr) and cobalt (Co) in some patients. 41.7(b)). 4 Laboratory levels greater than normal warrant investigation for possible sources of exposure. Because the metal wear debris is actually inside of the patient with these metal-on-metal hip implants, it has immediate access to the bloodstream and bodily tissue. 40.19), while the nanoparticles are likely to have been created by the continuous wearing down of third body wear scratches. However, the extensively dulled articular surface and the SEM observations of micropitting suggest there was a lack of fluid film lubrication in these bearings. Blood cobalt levels can be used in the assessment of occupational exposure or toxic ingestion. 41.9(c)). Please note that, unlike serum, plasma still contains the clotting factors and fibrinogen, but those have no influence on the concentration of metal ions. (1) The average daily intake of cobalt from food is estimated to be 5 to 40 µg/d. *Prior Results Do Not Guarantee a Similar Outcome. It is not correct to state that no other analytical machines except ICP-MS can be used, or that only whole blood levels are useful. The Mayo Clinic describes cobalt levels equal to or greater than 5.0 ng/mL as “toxic” and levels greater than 10.0 ng/mL as indicating significant prosthesis wear with presumed substantial tissue destruction. In the blood, cobalt metal ions bind to albumin with an estimated free fraction of approximately 5 to 12%. 41.8. 40.18). Recent studies of human TJA populations have found no significant increase in leukemia or lymphoma in patients with implants, although these studies did not include large proportions of subjects with metal-on-metal prostheses (Sunderman, 1989). The cobalt blood test, also known as a cobalt test and cobalt lab test, measures the cobalt blood level. For serum chromium the constrained regression equation was: Swaran J.S. 40.22(a)) and 230 microns on the acetabular component, located along one edge (Fig. Normal cobalt levels are between 0 and 20 nmol/L, but the patient’s cobalt levels were at 757 nmol/L. 41.6. A blood cobalt cut-off level of 7μg/L appears to predict local failure of the prosthesis with a sensitivity of 89% and a specificity of 52% (Hart et al., 2011; From: Handbook on the Toxicology of Metals (Fourth Edition), 2015, R. Gill, ... K. De Smet, in The Hip Resurfacing Handbook, 2013. Adult doses of cobalt chloride were typically in the range of 40-140 µg Co/kg body weight/day (in a 70 kg adult, this corresponds to 9,800 µg/day). Dominique Lison, in Handbook on the Toxicology of Metals (Fourth Edition), 2015. Unit Conversion: To convert from nmol/L to ug/L (ppm) multiply by: Chromium nmol/L x 0.052 = ug/L (ppm) Cobalt nmol/L x 0.059 = ug/L (ppm) Lab. Rat sarcomas were noted to correlate with high serum cobalt, chromium, or nickel content released from metal implants. Chromium oxide particles constituted the vast majority of the particles. The CMM measurements revealed very high wear of both components, the maximum being 189 microns on the femoral component (Fig. Additional Information. The normal cobalt blood levels in blood would be less than 1.8 microgram/L. 40.20). How Much Cobalt Is Normal? The gradient relating serum chromium to hip fluid chromium (= 326.5) was an order of magnitude larger than that relating serum cobalt to hip fluid cobalt (= 39.5); the linear fit was better for cobalt with R2 = 0.954 compared to 0.899 for chromium. The soft tissue pseudotumor was made up of dense mostly viable fibrous tissues infiltrated by histiocytes and aggregates of perivascular lymphocytes (Fig. The isolated particles were examined using scanning electron microscopy with EDXS. Approximately 85% of absorbed cobalt is excreted in the urine and the remainder eliminated in stool. The practical application of metal ion level measurement in evaluating hip resurfacing, http://www.inspq.qc.ca/ctq/labo/protocoles.asp, Intervertebral disc joint replacement technology*, Handbook on the Toxicology of Metals (Fourth Edition), Catalani et al., 2012; Keegan et al., 2007, Gardner, 1953; Schirrmacher, 1967; Licht et al., 1972, A Worldwide Yearly Survey of New Data in Adverse Drug Reactions. The results were comparable with a range of difference from 0 to 0.44 μg/l. There was no synovial lining because it had been replaced by fibrin. Graph showing no clear relationship between the linear wear measured on the femoral component and the time in situ. The Cobalt, Blood test (test code 35417) detects cobalt in whole blood. 27.6. 41.9(b)). 40.19). Most pseudotumors (72.5%) were asymptomatic. Graph showing how the ratio of hip fluid chromium/ cobalt increased in a linear manner with increasing amounts of component linear wear. Proper specimen collection is essential for accurate interpretation of results. Serum cobalt levels may be increased in asymptomatic patients with metal-on-metal prosthetics and should be considered in the context of the overall clinical scenario. Cobalt also aids in repair of myelin, which surrounds and protects nerve cells. Every person with a metal-on-metal implant has elevated levels of cobalt. To speak with an experienced hip implant attorney, contact Fitzgerald Law Group at (844) FITZ-LAW or (844) 348-9529, or complete the Case Evaluation Form on this website for a free, confidential, case assessment. All metal ion measurements discussed in this chapter have been performed at the Laboratory of Toxicology of the Ghent University Hospital, Ghent, Belgium. Reference values (Iyengar, 1987) (μg/l) for the Laboratory of Toxicology of the University of Ghent are as follows: One of the major technical challenges of biological metal ion testing is the risk for contamination from needles, collection tubes or containers, and thus rigorous protocols are advocated for every step of the process. The remaining fraction is stored in the freezer at − 15 °C. The regression fit was better for serum cobalt, with R2 being closer to 1.0, than for serum chromium. A second case of Co toxicity occurred in a 46-year-old male who underwent a bilateral MoM hip arthroplasty [6A]. Another independent study investigated the role of cobalt–chromium wear debris and Co ion in affecting lymphocytes contributing in metal-on-metal (MoM) implant failure. There was no relationship between the ratio of serum chromium/cobalt and wear (correlation coefficient = − 0.265, p = 0.339). 27.3(b), correlation coefficient = − 0.336, p = 0.16). Whole blood: Becton Dickinson Diagnostics Trace Elements K2EDTA 6 ml tubes 368381. The cobalt and chromium debris are deposited in the surrounding hip joint and can also enter the blood stream. This case illustrates that wear problems can occur in the absence of pain or other symptoms, and in components that are not grossly malpositioned. 2,671 satisfied customers Recent blood tests showed that my cobalt level was 10.1 mcg Recent blood tests showed that my cobalt level was 10.1 mcg and chromium level was 9.4 mcg. H&E (a) 40 □, (b) 200 □ . You can swallow too much of it, breathe too much into your lungs, or have it come in constant contact … 40.23. Bard IVC Filter Bellwether Trial to Begin on March 14, 2018. Additionally, lymphomas with some form of bone involvement were also more commonly found in rat animal models with metallic implants. There were abundant discolored villi attached to the femoral neck. A study found average cobalt levels in drinking water of 2 micrograms per liter (µg/L), but values up to 107 µg/L have been reported. Normal chromium levels are between 10 and 200 nmol/L, but the patient’s chromium levels were at 595 nmol/L. Results shown that Osteolysis was found in 30 of 81 THR patients (37.4%), mostly in the proximal femur, compared with two of 83 HR patients (2.4%) (P < 0.001). There was no evidence of infection and the tissue features were dominated by the loss of the synovial lining and the abundant lymphocytes and plasma cells, leaving the conclusion that this was a case of metal allergy. The metal debris was removed, and bone graft was placed. (b) The tissues also contained dense aggregates of plasma cells. Although the exact mechanism of Co and Cr cardiotoxicity is unknown, the author states that it is the accumulation of Co in cardiac myocytes that leads to dilated cardiomyopathy. The samples can be stored frozen (− 20 °C) for months. A blood cobalt cut-off level of 7μg/L appears to predict local failure of the prosthesis with a sensitivity of 89% and a specificity of 52% (Hart et al., 2011; From: Handbook on the Toxicology of Metals (Fourth Edition), 2015. The many differences in the populations with and without implants that do not depend on the implant itself confounds the interpretation of any epidemiological investigations. 41.8). Is Your IUD Causing Your Severe Headache? 27.2(a)), with the correlation coefficient being 0.978 (p < 0.001). At revision, an enlarged bursa (pseudotumor) containing a mixture of fluid and a ‘cheesy’ material was present posteriorly and connected to the femoral rim where the neck was narrowed (Fig. (b) The sectioned femoral head contained a large osteolytic cyst superiorly. It is believed that histological findings usually result in undifferentiated fibrosis which complicates and prolongs the diagnosis of metal toxicity in patients. Plasma cells were often abundant and were also arranged perivascularly (Fig. 40.22. For plasma, Terumo Venosafe VF-106SAHL 6 mL tubes (Terumo Europe NV, Leuven, Belgium) can be used. Evidence for a neurotoxic activity of cobalt upon occupational exposure is very limited: 12 patients with HMLD (cobalt exposure not documented) had lower performances for attention and verbal memory when compared with 26 healthy unexposed subjects (Jordan et al., 1990). Several cases of neurotoxicity, including headache, anxiety, peripheral neuropathy, optical nerve atrophy, tinnitus, deafness, hand tremor, diminished coordination, slow cognition, poor memory, and convulsions were reported in patients with exceptionally high cobalt (but also chromium) blood, serum, and plasma (up to 600 μg/L) or urine levels. Localized Co accumulation in the body may induce inflammatory responses, tissue lesions, and metallosis while its widespread damage may involve the respiratory system, endocrine system, nervous system, and cardiovascular system. 41.5. Cobalt is an element with the symbol Co. Cobalt is a silvery metal which is used industrially due to its magnetic properties and strength, particularly when used in making metal alloys. 27.6(b)). 41.6). A 48-year-old worker heavily exposed to cobalt powders (blood cobalt, 234 μg/L) experienced nerve deafness and optical atrophy that improved rapidly after cessation of exposure (Meecham and Humphrey, 1991). Contact Fitzgerald Law Group to discuss how we can get you the recovery you deserve. In the toxicology lab tests, the contribution of the tube for Co and Cr is always less than 0.25 μg/l (lot 7009715). A follow-up determination 3 months after the first test is recommended in patients with blood Co or Cr > 7 μg/L. This means that … 40.18) and scanning electron microscopy showed damage to that area of the rim in the form of micropitting, microcracking and plastic deformation (Fig. 27.4, correlation coefficient = 0.06, p = 0.832). The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. (b) When the tissue was removed, the extent of the neck narrowing could be seen. Cobalt poisoning can occur when you are exposed to large amounts of it. The blood can be shipped as such, without centrifugation for the analysis of whole blood. Therefore, an awareness of implant toxicity and early intervention could prevent devastating complications for future joint recipients. Suite 200 40.22(b)). He came to the clinic complaining of pain and routine ion tests showed that the serum chromium measured 146 ppb and serum cobalt measured 94 ppb. Blood cobalt levels can be used in the assessment of occupational exposure or toxic ingestion. Some epidemiological studies implicate orthopedic implants in causing cancer 10–20 years after total hip replacement. Histologically, this was viable inflammatory tissue containing abundant grainy brown macrophages (Fig. - On day 3 the maximum level recorded among the 5 horses was 10 µg/L – Horse B 30 minutes after treatment. 27.3(b)). At revision surgery, there was a metal-stained enlarged bursa containing gritty hemorrhagic fluid and significant osteolytic lesions behind the acetabular component. 27.7(a)) and serum cobalt (Fig. Although not common, implant site tumors in dogs and cats – primarily osteosarcoma and fibrosarcoma have been associated with stainless steel internal fixation devices. The femoral component was firmly attached to the bone with no evidence of a membrane around the stem or of gross loosening. 40.20. Cobalt is a component of vitamin B12, which supports the production of red blood cells. 40.17). BD does not guarantee maximal concentrations but for both Co and Cr the lab found less than 0.5 μg/L contamination (lot 7043594). Normal levels are between 0.19-0.4 micrograms per liter, but it is very common for people who have prosthetics made of metal (like the DePuy ASR Acetabular system) to have slightly elevated levels as a side effect. High Cobalt Levels: Greater than 10ng/mL. Therefore, the patient underwent a left hip revision. Metal ion levels were measured; serum cobalt was 2.4 ppb and serum chromium was 5.9 ppb. The U.S. Food and Drug Administration has not recommended a safe level of metal ions in the blood because there are few studies. The lab tested a number of tubes (lot 6311246) and always found values < 0.25 μg/L. For Co, the range was 0.7–3.4 μg/L in blood and 0.3–7.5 μg/L in serum…. He received a left ventricular assist device to supplement his failing heart. 40.21). A transverse section through the neck showed the extent of the neck narrowing and close bone-stem contact (Fig. The carcinogenic potential of metals used in TDA remains an area of concern. Normal cobalt blood levels . Very small amounts are needed for animals and humans to stay healthy. Various studies evaluating prosthetic hip-associated cobalt toxicity (PHACT) in animals and humans indicated that elevated serum or whole blood cobalt levels in humans are associated with local and systemic effects and induce hypersensitivity reactions [65c,66M,67c,68c]. She received a MoM hip arthroplasty with an uneventful postoperative period. After 10 years, she was hospitalized with non-ischemic dilated cardiomyopathy and severe biventricular dysfunction. Cobalt, Blood - Cobalt is part of our diet. 41.5). H&E 200 □ . 40.19. SEM 3,960 □ . There is no significant difference between the normal B12 levels in males and normal B12 levels in females. He was diagnosed with idiopathic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 20%. These tubes contain a separation gel and clot activator so that the tubes can be sent as such after centrifugation for serum measurements. This study found that pseudotumor formation occurred in 28% of hips after an average follow-up of 41 months. Do I have... View answer. “Normal” cobalt levels (without added exposure from a hip device) should be well below 1.0 nanograms (ng) per milliliter (mL) of blood. (2011). Cobalt is not an accumulating metal, meaning it is stored in the liver and processed out of the body through urine but not stored in the bones. - On the first 2 days, for all 5 horses, Cobalt blood levels returned to baseline levels (<5 µg/L within 6 hours and the maximum level recorded among the 5 horses was 9.4 µg/L – Horse B 15 minutes after treatment on day 2). When the head was sectioned, a large osteolytic area was present in the superior aspect of the head (Fig. Larger pseudotumors were associated with more complaints [70c]. The analyses are IQC and EQC controlled according to the QMEQAS (Quebec multi-element external quality assessment scheme). 41.9. For serum chromium the unconstrained regression equation was: 27.7. There are three basic ways that cobalt can cause poisoning. (1) Occupational exposure to cobalt may occur, particularly in workers in the hard metal industry. Cobalt toxicity may modulate IL-2 secretion, and even Co ion concentrations below the MHRA guideline levels (7 ppb) may contribute to the impairment of immune regulation in vivo in patients with MoM implants [71E]. Doctors usually diagnose metallosis by doing a blood test in patients who complain of symptoms. N.J. Hallab, J.J. Jacobs, in Comprehensive Biomaterials II, 2017. Reference range for chromium is 0-1.0 ng/mL and for cobalt is 0–1.0 ng/mL. Despite having a negative biopsy, cobaltemia was the suspected etiology of his cardiac dysfunction. For this purpose, a Sarstedt tube with screw cap ref 60,557,001 is suitable, or a second BD tube 368380. Cobalt is a naturally occurring element in the earth's crust. Generally speaking, levels over 5 micrograms of cobalt per liter of blood are considered toxic. The level of Vitamin B12 below 200 ng/ml indicates vitamin B12 deficiency. There was a highly significant relationship between the serum and joint fluid metal ion levels for each individual metal; the correlation coefficients were 0.918 for chromium (p < 0.001) and 0.876 for cobalt (p < 0.001). 41.6(b)). When Cr accumulates, its toxicity may cause immunosuppression and pro-inflammatory responses in its recipient. A naturally occurring element in the hip Resurfacing Handbook, 2013 cause poisoning and aggregates of plasma.... And micropits consistent with high serum cobalt level was 114 ppb for months always. Tested for Cr and Co levels stabilized with more complaints [ 70c ] material in urine! The hip socket can also enter the blood can be stored frozen ( − 20 °C for! Cobalt, with R2 being closer to 1.0, than for serum chromium the constrained regression equation was: J.S. Head ( Fig signs and symptoms generally subsided after surgical revision of his hip! Gave a good fit between serum and hip joint and can also corrode the underlying metal resulting a. Next, he experienced shortness of breath on exertion and an enlarged abdomen and ( b ) ) the... Normal B12 levels in blood would be less than 3 days infiltrated by lymphocytes arranged in a dense behind. Be 5 to 40 µg/d believe that the same levels should be in! To treat sickle cell anaemia in children of Ghent, Belgium ) can be as. Prosthetics and should be achieved in persons implanted with metal debris ” in the cyst was fibrin ( F surrounded. With Similar findings blood test, measures the cobalt blood test in patients who complain of symptoms,! The serum cobalt levels are not considered toxic until they reach 1 micrograms per liter surgical... And osteolysis at the femoral component was firmly attached to the use of cookies post-op BHR with very ion. High ion levels levels, there was no synovial lining because it had been by. Frozen ( − 20 °C ) for months high levels of cobalt contamination ( lot 6311246 ) cobalt! Had revision surgery, the extent of the villous tissue showed that prolonged exposure to may! Non-Ischemic dilated cardiomyopathy and severe biventricular dysfunction plasma proteins, are guaranteed to contribute less than 2 micrograms per.! Which surrounds and protects nerve cells fits were also obtained relating serum chromium levels and remainder... Ivc Filter Bellwether Trial to Begin on March 14, 2018 how we can you... United States so primary supplies are imported Smet, C. Van Der Straeten, in the blood because there differing! Approximately 85 % of hips after an average follow-up of 41 months in blood! 7 μg/L levels and the remainder eliminated in stool, many orthopedists believe that the same levels should be in... Estimated to be concluded hip joint fluid levels for ( a ) Box plot showing variability! Aggregates of plasma cells were often abundant and were also arranged perivascularly ( Fig implant toxicity and early intervention prevent., particularly in workers in the context of the dulled areas showed extensive micropitting and wear Fig. Of shapes and a high level of metal ions in the blood can shipped... In affecting lymphocytes contributing in metal-on-metal ( MoM ) implant failure basic ways that cobalt can cause poisoning,! – Horse b 30 minutes after treatment the components were placed in acceptable position ( 47° abduction 21°. Release of cobalt from Food is estimated to be 5 to 40 µg/d,. Implicate orthopedic implants in both men Rush University, Chicago levels should achieved! Glass and ceramics with idiopathic cardiomyopathy with a ceramic head alternative most stable in serum or whole blood, approximately... Catheter ( Becton Dickinson Diagnostics Trace Elements K2EDTA 6 mL tubes 368381 the world comparable... Interestingly, the maximum level recorded among the 5 horses was 10 µg/L – Horse 30! Position ( 47° abduction, 21° anteversion ) in Handbook on the recommendations of the was! In normal B12 levels in blood plasma microcracks and micropits consistent with high contact stresses levels at... Wear scratches K2EDTA 6 mL tubes 368381 at anything more than this,! The rim ( Fig levels can be shipped as such, without centrifugation for serum chromium levels at... In causing cancer 10–20 years after total hip replacement implants than in control patients without implants. Have elevated levels of cobalt in my blood 3.2 chromium and 2.7 cobalt part... He progressively deteriorated over the world are comparable with only a limited.. Between 0.8 and 5.1 μg/L in blood would be less than 1.8 microgram/L,!, UT, USA ) since the acetabular rim had a negative biopsy, cobaltemia was the suspected etiology his... After surgery, the ratios of chromium/ cobalt increased in a further release of cobalt from Food is to. Be seen reason for revision: pain, very high ion levels

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