CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
J Appl Lab Med. 2023 Jul 5;8(4):674-688. doi: 10.1093/jalm/jfad019.
Assessment of trace and toxic element status is important for the diagnosis and monitoring of several pediatric conditions. Elemental deficiency and toxicity have serious implications, particularly in pediatrics wherein risk is higher. Pediatric reference intervals (RIs) for trace elements and normal exposure limits for toxic elements are lacking on modern analytical systems. Herein, reference values were established for 13 plasma and 22 whole blood trace elements in the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents.
Approximately 320 healthy children and adolescents were recruited with informed consent. Trace elements were measured in whole blood and plasma samples using 2 technologies: (a) triple quadrupole inductively coupled plasma tandem mass spectrometry (ICP-MS/MS) (n = 172) and (b) high-resolution sector field ICPMS (HR-SF-ICPMS) (n =161). RIs and normal exposure limits were then established according to Clinical and Laboratory Standards Institute guidelines.
Of all elements assessed, none required sex partitioning and 8 required age partitioning (e.g., copper, manganese, and cadmium). Reference value distributions determined via ICP-MS/MS and HR-SF-ICPMS demonstrated excellent concordance, with few exceptions (e.g., molybdenum, cobalt, and nickel).
These data represent the first study wherein pediatric RIs and normal exposure limits were derived simultaneously on 2 different clinically validated MS platforms which provide urgently needed data to inform clinical decision-making for trace elements in pediatrics. Study findings suggest some trace elements require age-specific consideration for appropriate interpretation. Highly concordant observations across the 2 analytical methods also demonstrate the comparability and reliability of results obtained on both platforms.
痕量和有毒元素的评估对于几种儿科疾病的诊断和监测非常重要。元素缺乏和毒性会产生严重影响，尤其是在儿科，风险更高。现代分析系统缺乏儿科微量元素参考区间 (RI) 和有毒元素正常暴露限值。在此，通过加拿大儿科参考区间倡议 (CALIPER) 队列中健康儿童和青少年的 13 种血浆和 22 种全血痕量元素建立了参考值。
大约 320 名健康儿童和青少年在知情同意的情况下被招募。使用 2 种技术（a）三重四极杆电感耦合等离子体质谱串联质谱法 (ICP-MS/MS)（n = 172）和（b）高分辨率扇形场 ICPMS (HR-SF-ICPMS)（n = 161）测量全血和血浆样本中的痕量元素。然后根据临床和实验室标准协会指南建立 RI 和正常暴露限值。
在所评估的所有元素中，没有一个需要性别分区，有 8 个需要年龄分区（例如铜、锰和镉）。通过 ICP-MS/MS 和 HR-SF-ICPMS 确定的参考值分布表现出极好的一致性，只有少数例外（例如钼、钴和镍）。
这些数据代表了第一项同时在 2 种不同临床验证的 MS 平台上得出儿科 RI 和正常暴露限值的研究，为儿科微量元素的临床决策提供了急需的数据。研究结果表明，一些痕量元素需要针对特定年龄进行考虑，以进行适当的解释。两种分析方法高度一致的观察结果也证明了两种平台上获得的结果的可比性和可靠性。
