The MHRA advice is the result of much work over the past few years looking at this problem in the UK and other countries.  The advice was written with input from some of the SAS labs, although they ignored suggestions about reporting units, and have suggested action levels based on ppb rather than SI units.  The increased levels of metals in blood is an indicator of wear in the prosthesis and can contribute to a decision to revise the operation.  Very high metal concentrations can also be seen in synovial fluid collected either by biopsy or at operation, and is sometimes also requested.  The simplest sample to take is whole blood, but it must be collected in a trace element free tube.  Suitable tubes are available with either EDTA or Na heparin.  I am currently preparing a review of this topic for the Annals, which will be completed as soon as possible.

 

The assays are available from all of the SAS trace element labs, and chromium and cobalt have recently been added to the TEQAS scheme, so other labs can be assured that the assays are reliable.  It is not the place here to give the costs from my lab: those interested should contact their preferred lab for costs and other details. 

 

So far as I know funding of the pathology, imaging and orthopaedic outpatient visits was not a part of the discussions on the document.

 

Best wishes

 

Barry

 

 

 

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:ACB-CLIN-CHEM-GEN@JISCMAIL.AC.UK] On Behalf Of Jessica Schroeder
Sent: Thursday, May 06, 2010 4:22 PM
To: ACB-CLIN-CHEM-GEN@JISCMAIL.AC.UK
Subject: Cobalt and Chromium in hip replacements