![]() ![]() Crutsen JRW, Koper MC, Jelsma J, et al: Prosthetic hip-associated cobalt toxicity: a systematic review of case series and case reports. Lison D, De Boeck M, Verougstraete V, Kirsch-Volders M: Update on the genotoxicity and carcinogenicity of cobalt compounds. De Smet K, De Hann R, Calistri A, et al: Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. Keegan GM, Learmonth ID, Case CP: A systematic comparison of the actual, potential, and theoretical health effects of cobalt and chromium from industry and surgical implants. Tower SS: Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. However, the US Food and Drug Administration recommends testing cobalt in EDTA anticoagulated whole blood in symptomatic patients with metal-on-metal implants.ġ. Increased serum trace element concentrations in the absence of corroborating clinical information do not independently predict prosthesis wear or failure. Serum concentrations above 10 ng/mL in a patient with cobalt-based implant suggest significant prosthesis wear. Modest increase (4-10 ng/mL) in serum cobalt concentration is likely to be associated with a prosthetic device in good condition. Prosthesis wear is known to result in increased circulating concentration of metal ions. There are no Occupational Health and Safety Administration blood or urine criteria for occupational exposure to cobalt. If cobalt exposure is due to orthopedic implant wear, there are no large case number reports associating high circulating serum cobalt with toxicity. If cobalt is ingested, concentrations greater than 5 ng/mL suggest major exposure and likely toxicity. ![]() Cobalt concentrations associated with toxicity must be interpreted in the context of the source of exposure. ![]() This list of products is incomplete, and these products change occasionally see prosthesis product information for each device for composition details.Ĭoncentrations greater than or equal to 1.0 ng/mL indicate possible environmental or occupational exposure. Prosthetic devices produced by DePuy Company, Dow Corning, Howmedica, LCS, PCA, Osteonics, Richards Company, Tricon, and Whiteside are typically made of chromium, cobalt, and molybdenum. Serum cobalt concentrations are likely to be increased above the reference range in patients with joint prosthesis containing cobalt. The inhalation of dust during machining of cobalt alloyed metals can lead to interstitial lung disease. Chronic symptoms include pulmonary syndrome, skin disorders, and thyroid abnormalities. Acute symptoms are pulmonary edema, allergy, nausea, vomiting, hemorrhage, and kidney failure. Cobalt deficiency has not been reported in humans.Ĭobalt is not highly toxic, but large doses will produce adverse clinical manifestations. The radioactive isotope of cobalt, (60)Co, is used as a gamma emitter in experimental biology, cancer therapy, and industrial radiography.Ĭobalt is an essential cofactor in vitamin B12 metabolism. Previously, cobalt salts were sometimes used as foam stabilizers in the brewing industry this practice was banned due to the cardiovascular diseases it induced. Cobalt salts are used in the glass and pigment industry. ![]() See Metals Analysis Specimen Collection and Transport for complete instructions.Ĭobalt is rare but widely distributed in the environment, used in the manufacture of hard alloys with high melting points and resistance to oxidation cobalt alloys are used in manufacture of some artificial joint prosthesis devices. 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.ģ. Carefully pour specimen into a Mayo metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Allow the specimen to clot for 30 minutes then centrifuge the specimen to separate serum from the cellular fraction.Ģ. Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vialġ. Supplies: Metal Free Specimen Vial (T173)Ĭollection Container/Tube: Plain, royal blue-top Vacutainer plastic trace element blood collection tube If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours. Patient Preparation: High concentrations of gadolinium and iodine are known to interfere with most metal tests. ![]()
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