Department

Toxicology

Preferred Sample Type

Aluminium

Suitable Specimen Types

  • Li Hep
  • Blood in Dark Blue Top Tube
  • Li Hep Plasma
5mL blood (Lith Hep acceptable)

Sample Processing in Laboratory

Place in Trace Element rack in Send Away Fridge.

Sample Preparation

Lithium Heparin tube required. No need to separate.

Turnaround Time

3 working days

Sample Stability

4oC

Aluminium

General Information

Toxicity

Aluminium toxicity mainly arises in patients with chronic renal failure who are undergoing treatment either by conservative means or by maintenance haemo or peritoneal dialysis. Greatly elevated serum aluminium concentrations in these patients are clearly associated with the symptoms of dialysis encephalopathy (speech disorder, dementia, convulsions and death) and dialysis osteodystrophy (osteomalacia frequently resistant to treatment with vitamin D or its active metabolites). Aluminium accumulation may be responsible, in part at least, for the anaemia and soft tissue calcification of chronic renal failure. High concentrations may also be cardiotoxic.

The increased body burden comes from two sources.

  1. Firstly, oral aluminium hydroxide is widely used as a phosphate binder, and the normal intestinal absorption may be enhanced in chronic renal failure.
  2. Secondly, dialysis fluid may have a high aluminium content arising from impurities in the salts used in its manufacture,  the containers in which it is stored or  from the preparation of the fluid by dilution of a concentrate with water having a naturally high aluminium concentration, or to which aluminium has been added by the local Water Authority as a flocculent to remove coloured matter. Increasing use of reverse osmosis for water purification has greatly reduced intake from this source, leaving oral aluminium as the main hazard.

The aluminium content of certain blood products and intravenous fluids may pose a considerable risk to individuals receiving them on a long term basis, particularly premature infants in whom renal function may be impaired.

Also, rare occupational exposure from working in factories and warehouses where aluminium is  produced or welding takes place may increase exposure. Occupational exposure to dust containing finely divided aluminium may cause pulmonary fibrosis. It has been suggested that uptake of aluminium into brain may be responsible for the symptoms of Alzheimer’s disease.

Deficiency

Aluminium is a non-essential trace element with little known about its biological function. There has been no known cases of Aluminium deficiency and its measurement in this situation is not required.

Patient Preparation

Metal needles and cannulae must be flushed by drawing 2-3mL of blood into a syringe and discarding the sample. Use a new syringe for the sample that is to be used for aluminium analysis.

Notes

Requested in patients with chronic renal failure.

Water & Dialysis fluid can be measured.

Reference Range

<0.37 umol/L: Normal (no history of CRF).

<2.22 umol/L: Desirable in CRF patients.

>2.22 umol/L: Excessive accumulation.

>3.70 umol/L: Cause for concern, high risk of toxicity in children.

>7.41 umol/L: Urgent action required; High Risk of toxicity in all.

Specifications

  • EQA Scheme?: Yes
  • EQA Status: TEQAS

The laboratories at Heartlands Hospital, Good Hope Hospital and Solihull Hospital form part of the services provided by University Hospitals Birmingham and are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217
  • United Kingdom Health Security Agency laboratory is a UKAS accredited medical laboratory No.8213

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database: http://www.heftpathology.com/frontpage/test-database.html.

Protection of personal information - Laboratory Medicine comply with the Trust Data Protection policy and have procedures in place to allow the Directorate and its employees to comply with the Data Protection act  1998 and associated best practice and guidance.

For further information contact Louise Fallon, Quality Manager, 0121 424 1235

UKAS HEFT