Newcastle Laboratories

Aluminium, Al

Clinical Background:

Patients in end-stage renal failure lose the ability to clear aluminium and are susceptible to aluminium toxicity. Aluminium present in dialysis water can expose dialysis patients to aluminium. If ...

Patients in end-stage renal failure lose the ability to clear aluminium and are susceptible to aluminium toxicity. Aluminium present in dialysis water can expose dialysis patients to aluminium. If it is not removed by renal filtration, aluminium accumulates in the blood, where it binds to proteins such as albumin and is rapidly distributed throughout the body. Aluminium overload leads to accumulation in the brain and bones. Brain deposition has been implicated as a cause of dialysis dementia. In bone, aluminium replaces calcium at the mineralization front, disrupting normal osteoid formation.

It is mandatory that water used in haemodialysis is initially purified by reverse osmosis. The Renal Association has published guidelines recommending limits of various trace elements and pathogens in reverse osmosis water. It is suggested that aluminium content of purified water should be carried out every 3 months.

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Test Details

  • Discipline:

    Biochemistry

    Biochemistry

  • Specimen Container Adult:

    Plastic Z10 tube

    Navy blue-top serum trace element tube (available on request from Blood Sciences reception at both Freeman and RVI sites)

    Plastic Z10 tube

    Navy blue-top serum trace element tube (available on request from Blood Sciences reception at both Freeman and RVI sites)

  • Specimen Container Paediatric:

    Plastic Z10 tube

    Navy blue-top serum trace element tube (available on request from Blood Sciences reception at both Freeman and RVI sites)

    Plastic Z10 tube

    Navy blue-top serum trace element tube (available on request from Blood Sciences reception at both Freeman and RVI sites)

  • Minimum Volume Adult:

    1 mL blood

    1 mL water

    1 mL blood

    1 mL water

  • Minimum Volume Paediatric:

    1 mL blood

    1 mL water

    1 mL blood

    1 mL water

  • Special Requirement:

    Blood

    Collect via cannula or dialysis line as 2nd or 3rd sample. Avoid dust (source of contamination).

    Water

    Allow water to run from source for 30 seconds prior to collecting sample. Avoid dust (so...

    Blood

    Collect via cannula or dialysis line as 2nd or 3rd sample. Avoid dust (source of contamination).

    Water

    Allow water to run from source for 30 seconds prior to collecting sample. Avoid dust (source of contamination).

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  • Sample Stability:

    Samples are stable for 6 weeks at 4°C or indefinitely when frozen.

     

    Samples are stable for 6 weeks at 4°C or indefinitely when frozen.

     

  • Transport Requirements:

    Ambient temperature.

    Ambient temperature.

  • Quality Assurance:

    Trace Element Quality Assurance Scheme (TEQAS) for Trace Elements

    Trace Element Quality Assurance Scheme (TEQAS) for Trace Elements

  • Interpretation:

    Patients with renal insufficiency are susceptible to aluminium toxicity. There are several factors associated with dialysis procedures that may potentiate aluminium toxicity, including:
    ·        al...

    Patients with renal insufficiency are susceptible to aluminium toxicity. There are several factors associated with dialysis procedures that may potentiate aluminium toxicity, including:
    ·        aluminium in dialysis water
    ·        dialysis processes that may not be efficient at eliminating aluminium
    ·        use of oral phosphate-binder gels containing aluminium that is absorbed by the gut.

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  • Reference Ranges:

    Serum:

    (Supra-regional Assay Service cut-offs for serum aluminium in dialysis patients)


    Comment

    Aluminium (µmol/L)

    No history of chronic renal failure (CRF)

    Little risk of toxicity in C...

    Serum:

    (Supra-regional Assay Service cut-offs for serum aluminium in dialysis patients)


    Comment

    Aluminium (µmol/L)

    No history of chronic renal failure (CRF)

    Little risk of toxicity in CRF patients

    Excessive accumulation; risk of toxicity in children

    Cause for concern; risk of toxicity in children

    High risk of toxicity in all patients

    <0.4

    <2.2

    >2.2

    >3.7

    >7.4


     

    Water:

    (European Guidelines for Water / Dialysis fluid aluminium)

     

     

    Comment

    Aluminium (µmol/L)

    Reverse osmosis water

    Dialysis water/fluid

    Drinking (tap) water

    <0.4

    <1.1

    <7.4


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  • Factors Affecting Result:

    Failure to adhere to correct specimen collection procedures can cause abnormal results due to specimen (dust) contamination, which can lead to misinterpretation and misdiagnosis.

    Failure to adhere to correct specimen collection procedures can cause abnormal results due to specimen (dust) contamination, which can lead to misinterpretation and misdiagnosis.

  • Routine Contact Name:

    Duty Biochemist

  • Routine Telephone:

    Freeman: 0191 244 8889
    RVI: 0191 282 9719

    Freeman: 0191 244 8889
    RVI: 0191 282 9719

  • Routine Email:

    - For external users: TNU-Tr.duty.biochemist@nhs.net

    - For Trust users: DutyBiochemist@nuth.nhs.uk

  • Specialist Test:

    Yes

    Yes

Availability:

Available during full access hours
Assayed as service demands
Site of analysis: Freeman

Turn Around:

Within 4 weeks

Send To:

Department of Blood Sciences

Freeman Hospital
Freeman Road
Newcastle upon Tyne
NE7 7DN

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