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Dr Steph Martin
Consultant Clinical Scientist
Clinical Lead for Specialised Clinical Chemistry
Sheffield
What is ICP-MS
• Inductively
• Coupled
• Plasma
• Mass
• Spectrometer
• Developed in 1980
• First commercially available in 1987
• Becoming increasingly popular in clinical
labs
• Used for elemental and isotope analysis
Why is it so useful?
• Can detect and quantitate most of the elements
in the periodic table
• Can differentiate between different isotopes of
the same element
• Extremely sensitive
• Small sample volumes
• Fast, reasonably automated
• Semi-quantitative mode scans all elements to
identify possible toxicity
General principle
• A plasma is used to
– Obliterate sample into constituent elements
– Ionise the sample into positive ions
• In the MS ions are separated by mass and
detected
A typical ICP-MS
Inside….
The plasma
The plasma
• The plasma is 6000-8000 °C
• Formed by a flow of argon and a strong
electrical current
• Used to instantly breakdown the sample
into constituent elements and form positive
ions
• Made within a quartz tube called the
‘Torch’
Importance of the ionisation potential
The mass spectrometer
• Separates ions by mass: charge ratio
• Contained within a vacuum
• Applies a magnetic field to the ions, only
ions of correct mass will reach the detector
It isn’t perfect
• Polyatomic interferences
• Gadolinium interference on selenium
• Contamination
• Carryover
Polyatomic interferences
• Occurs when 2 ions stick together and have the
same mass as the element we are looking for
• Usually found with argon containing compounds
formed in the plasma
• Examples include:
– 75As (mass 74.92) with 40Ar35Cl (mass 74.93)
– 80Se with 40Ar2
Avoiding interferences
• Using interference equations
– Complex equations using the relative
abundances of the isotope and the ‘doubly
charged’ rate
• Use a different isotope of the same
element (where possible)
• Use a collision gas
Gadolinium
• Used as a radiology contrast media (in CT
and MRI scans)
• Molecular mass 157.25
• Molecular mass of two selenium ions
157.92
• Scan for Gd when assaying selenium
• Allow time for it to be excreted before
collecting sample for selenium assay
Contamination
• Sensitivity of detection means any
contamination can be a problem
• Zinc is very common, found in
– Glass
– Some plastics
– Cosmetics, powdered gloves…..
• Glassware cannot be used!
Contamination
• Chromium is present in stainless steel
– Use of metal needles in venepuncture?
• Some trace elements can be found in
blood tubes
– Managanese particularly affected
– Can be reduced with the use of ‘trace element
free’ blood tubes
Clinical Applications
• Quantitation of specific elements
– e.g. zinc, copper, selenium, cobalt, chromium,
lead, molybdenum, manganese, lithium,
arsenic, aluminium, sodium/chloride (sweat)
• Scanning several elements to identify the
cause of toxicity, if unknown
• Almost any sample type can be used
Monitoring nutrition
• Patients with gastrointestinal disease may
have abnormalities in trace elements
– Increased losses (
– Reduced excretion (
– Reduced absorption
• Patients receiving nutritional support rely
on receiving appropriate supplementation
Manganese
• Manganese is excreted in the bile, in
cholestasis theoretical risk of toxicity
• No case reports of deficiency in PN
patients
• Reduction in recent years of manganese
content of PN additives
Copper
• Copper is excreted in the bile, in
cholestasis theoretical risk of toxicity
• Deficiency is seen in PN patients
• An acute phase reactant
• Symptoms of deficiency include:
– Reduced white cell count, hypochromic
anaemia
Zinc
• Deficiency well documented in PN
patients, if zinc not added to PN
• Deficiency more common in patients with
increased losses via pancreatic or
intestinal fluids
• Symptoms of deficiency include alopecia,
glossitis, skin lesion, poor healing,
confusion
Zinc
• Toxicity has not been documented in PN
patients
• Zinc is a negative acute phase reactant
(sequestered by the liver)
• Bound to albumin in circulation…should
we correct for this?
Selenium
• Deficiency in selenium well documented in
PN patients if selenium not added
• Manifests as cardiomyopathy and skeletal
myopathy
• Toxicity not seen in PN patients (and is
generally very rare)
Chromium
• Deficiency has been seen, but is very rare
– Suitability of assays?
• Excreted in the urine so renal patients
have increased risk of toxicity
• Added to PN solutions but is also a
contaminant
Molybdenum
• No reports of toxicity
• Little in the literature to support monitoring
• Limited case reports of deficiency
Iodine
• No reports of toxicity
• Deficiency possible if not added to PN
solutions
• Lack of definition of requirements
• Deficiency may result in hypothyroidism
Aluminium
• Present as a contaminant in some PN
solutions
• Excreted via kidneys, increased risk in
renal impairment
Monitoring nutrition
• NICE guideline CG32 “Nutrition support for
adults: oral nutrition support, enteral tube
feeding and parenteral nutrition” 2006
(updated 2017)
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Active ingredients: 1 millilitre of Each ampoule
Additrace contains: contains 10ml of
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