Sign in →

Test Code LABGDS Gadolinium, Serum

Additional Codes

Test Name in EPIC EPIC Test Code Mnemonic Mayo Test ID
GADOLIMIUM LABGDS GDS GDS

 

Reporting Name

Gadolinium, S

Useful For

An aid in documenting past exposure to  gadolinium-based contrast agents in serum specimens

Method Name

Inductively Coupled Plasma-Mass Spectrometry (ICP-MS)

Performing Laboratory

Mayo Medical Laboratories in Rochester

Specimen Type

Serum


Specimen Required


Patient Preparation: 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.

Supplies:

Metal Free B-D Tube (No Additive), 6 mL (T184)

Metal Free Specimen Vial (T173)

Collection Container/Tube: Plain, royal blue-top Vacutainer plastic trace element blood collection tube (T184)

Submission Container/Tube: 7-mL Mayo metal-free, screw-capped, polypropylene vial (T173)

Specimen Volume: 1.6 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 Mayo metal-free, polypropylene vial, avoiding transfer of the cellular components of blood. Do not insert a pipette into the serum to accomplish transfer, and do not ream the specimen with a wooden stick to assist with serum transfer.

3. See Trace Metals Analysis Specimen Collection and Transport in Special Instructions for complete instructions.

Additional Information: If ordering the trace element blood collection tube from BD, order catalog #368380.


Specimen Minimum Volume

0.4 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 14 days
  Ambient  14 days
  Frozen  14 days

Reject Due To

Hemolysis

Mild OK; Gross OK

Lipemia

Mild OK; Gross OK

Icterus

Mild OK; Gross OK

Other

NA

Reference Values

<0.5 ng/mL

Day(s) and Time(s) Performed

Thursday; 8 a.m.

CPT Code Information

83018

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GDS Gadolinium, S 80912-9

 

Result ID Test Result Name Result LOINC Value
29251 Gadolinium, S 80912-9

Method Description

Gadolinium (Gd) in serum and urine is analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) in standard mode using terbium (Tb) as an internal standard and a plasma matrix calibration.(Leung N, Pittelkow MR, Lee CU et al: Chelation of gadolinium with deferoxamine in a patient with nephrogenic systemic fibrosis. NDT Plus 2009;2[4]:309-311)

Cautions

Serum gadolinium concentration may be elevated if the specimen is drawn less than 96 hours after administration of gadolinium-based contrast agents (GBCA). This elevation is due to residual gadolinium present from contrast media infusion. An elevated serum gadolinium in a specimen collected more than 96 hours after contrast media infusion does not definitively indicate risk of nephrogenic systemic fibrosis (NSF) or significant gadolinium toxicity. Ultimately, patients should consult with their healthcare providers to interpret any test results.

Supportive Data

A small number of patients studied at Mayo Clinic have demonstrated measureable (0.6-2.1 ng/mL) gadolinium in serum collected 30 days after gadolinium infusion, so some prolonged elimination is possible.

 

Serum gadolinium concentrations above the stated reference range may indicate prolonged elimination, residual gadolinium retention, or continuing environmental exposure. However, elevated serum gadolinium concentrations do not necessarily indicate toxicity.

Interpretation

Elevated gadolinium observed in serum specimens drawn more than 96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal renal function, and may indicate prolonged elimination of gadolinium and exposure to anthropogenic sources.

Analytic Time

1 day

Specimen Retention Time

14 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

Clinical Information

Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media (gadolinium-based contrast agents: GBCA) for magnetic resonance imaging and computer tomography scanning.

 

Gadolinium is primarily eliminated via the kidneys, so exposure can be prolonged in patients with renal insufficiency. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes (1.5 hours). Patients with reduced renal function and some patients with normal renal function may exhibit a prolonged gadolinium elimination half-life.

 

To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF). NSF is a relatively uncommon condition in which fibrous plaques develop in the dermis and, often, in deeper connective tissues. Reported cases have occurred almost exclusively in patients with severe renal disease, and almost all have been associated with prior use of GBCAs. NSF is a painful skin disease characterized by thickening of the skin, which can involve the joints and cause significant limitation of motion within weeks to months. Over the past decade, changes in clinical practice guidelines have almost completely eliminated the incidence of NSF. However, the association of NSF and observed elevated gadolinium concentrations is still not fully understood.