Review of trace elements in blood, serum and urine for the Czech and Slovak populations and critical evaluation of their possible use as reference values.

The availability of accurate trace element reference values in human tissues represents an important indicator to the health status of the general population and occupational groups exposed to trace elements. The EURO TERVIHT project (Trace Element Reference Values in Human Tissues) aims to establish and compare trace element reference values in tissues from inhabitants of the European countries as baseline values for clinical/toxicological assessment studies. In this context, one of the first steps considered is the critical evaluation (state of the art) of existing literature on trace element reference values in blood, serum and urine in the general population of each European country. This paper reviews the Czech and Slovak situation by assessing studies carried out in these countries for Al, As, Cd, Co, Cr, Cu, F, Mn, Hg, Ni, Pb, Rb, Sc, Se, V and Zn in blood, serum and urine. These studies show that most of the data available do not meet criteria designed recently for deriving reference intervals, especially regarding the number of subjects, the age of population sample studies as well as the use of appropriate sampling techniques and quality assurance procedures. Elements which present the highest potential risk for health in Czech and Slovak populations and for which reference values should be urgently established are: Cd, Hg, Pb (major pollutants); As, Cr, Ni (carcinogenic metals); Al, F, Mn, Tl, V (released into the environment by coal combustion and other industrial activities); Pt (increasing use of Pt catalyst in petrol-driven automobiles); essential trace elements such as I, Se and Zn for which a deficiency in Czech and Slovak populations was detected or is suspected.