Thursday, April 5, 2012

Looking at blood, urine and plasma levels of Cr and Co metals post artheroplasty

Fascinating study of different ways to look at Chromium and cobalt levels.  The conclusion:  make sure when you are doing blood level readings that you are comparing apples and apples over time.  I noted sometimes I have received levels for three different things:
  • Blood levels
  • plasma levels
  • urine levels
As you can see in this study, you will get different results using these methods on the measurement of different metals which is why i look at all of them and compare all of them in a time series.  You can see my chart here:  http://www.mydepuyhiprecall.com/2012/03/chromium-and-cobalt-levels-4-months.html   (my recent levels were based on blood levels.  If you look at the urine levels, they look exceptionally high.)



J Orthop Res. 2012 Mar 23. doi: 10.1002/jor.22107. [Epub ahead of print]

Differential distribution of cobalt, chromium, and nickel between whole blood, plasma and urine in patients after metal-on-metal (mom) hip arthroplasty.

Source

Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, University of Liverpool, Prescot Street, Liverpool L7 8XP, United Kingdom. a.w.newton@liverpool.ac.uk.

Abstract

Evidence shows that raised cobalt (Co), chromium (Cr), and nickel (Ni) whole blood concentrations correlate with poor device outcome in patients following metal-on-metal (MoM) hip arthroplasty. To understand the local and systemic pathological effects of these raised metal concentrations it is important to define their distribution between whole blood, plasma, and urine. The metals were measured by Inductively Coupled Plasma Mass Spectrometry (ICPMS). Two hundred and five plasma, 199 whole blood, and 24 sets of urine samples were analyzed from 202 patients with Cr-chromium alloy MoM hip prostheses implanted between 8 months to 12 years (mean 6.0 years) prior to analysis. Plasma Co (median 39.1 nmol/L) showed significantly positive 1:1 correlation with whole blood Co (median 45.9 nmol/L; R(2)  = 0.98, p < 0.001, slope = 1.0). Plasma Cr (median 53.8 nmol/L) and whole blood Cr (median 40.3 nmol/L) were also correlated; however, concentrations were significantly higher in plasma indicating relatively little blood cell uptake (R(2)  = 0.96, p < 0.001, slope = 1.6). Urinary Co was up to threefold higher than Cr (median 334.0 vs. 97.3 nmol/L respectively). Nickel concentrations in whole blood, plasma, and urine were low relative to Co and Cr. The analysis shows fundamental differences in the physiological handling of these metals: Co is distributed approximately equally between blood cells and plasma, whereas Cr is mainly in plasma, despite which, Cr had far less renal excretion than Co. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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