Aluminum Toxicity Workup

  • Author: Jose F Bernardo, MD, MPH, FASN; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Aug 4, 2010
 

Laboratory Studies

Generally, findings from an aluminum level blood test are unreliable, as most of the body's stores are bound in bone and tissue and are not reflected in the serum value. A deferoxamine infusion test can be performed but may take more than 48 hours to yield a result (see Medical Care). Deferoxamine liberates aluminum from tissues by chelating it and leads to an increased serum level compared with one taken prior to infusion. The combination of a baseline immunoreactive parathyroid hormone level of less than 200 mEq/mL and a change in serum aluminum value of 200 ng/mL after deferoxamine is 90% specific and has a positive predictive value of 85% for aluminum toxicity.

Aluminum excess has a direct effect on hematopoiesis and has been shown to induce anemia. Findings on peripheral smears in patients with aluminum toxicity include microcytic anemia (hypochromic, normochromic), anisocytosis, poikilocytosis, chromophilic cells, and basophilic stippling. Note that these are the same findings observed in patients with lead poisoning. Aluminum can also be found in bone marrow macrophages.

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Imaging Studies

In radiographs, Looser zones (ie, lines of radiolucency parallel to the plane of growth in long bones) may be observed in severe cases, although they are more common with other causes of adult osteomalacia. Pathological fractures may also be observed. Bone scintigraphy shows a characteristic pattern in aluminum toxicity.

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Other Tests

Bone biopsy from the iliac crest is frequently performed to determine the etiology of bone disease in patients on dialysis because renal osteodystrophy can be multifactorial (eg, osteomalacia, uremic bone disease, hyperparathyroidism, aluminum deposition). Histochemical staining for aluminum and determination of osteoid volume, bone turnover rate, and osteoblast/clast cell count are some of the methods used for subtyping the bone disease.

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Procedures

Very few procedures are involved in the diagnosis of aluminum-related illness. Bone marrow biopsy is performed to distinguish between aluminum osteodystrophy and other causes of osteomalacia.

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Histologic Findings

Histologic findings in aluminum-related osteomalacia reflect the decrease in mineralization of newly formed bone matrix.

  • An increase in the surface covered by osteoid occurs, as does an increase in the osteoid seams.
  • Osteoid volume and thickness also increase.
  • In histologic sections stained with eosin, the areas of greater mineralization tend to appear violet or blue, whereas the osteoid seams appear pink.
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Contributor Information and Disclosures
Author

Jose F Bernardo, MD, MPH, FASN  Assistant Professor, Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh

Jose F Bernardo, MD, MPH, FASN is a member of the following medical societies: American Society of Nephrology and American Society of Transplantation

Disclosure: Nothing to disclose.

Coauthor(s)

Michael R Edwards, MD  Physician, Department of Emergency Medicine, Beebe Medical Center; Physician, Department of Emergency Medicine, Catholic Medical Center

Michael R Edwards, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American College of Physician Executives

Disclosure: Nothing to disclose.

Barbara Barnett, MD  Associate Program Director, Assistant Professor, Department of Emergency Medicine, Albert Einstein College of Medicine

Barbara Barnett, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Lisa Kirkland, MD, FACP, CNSP, MSHA  Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Harold L Manning, MD  Associate Professor, Departments of Medicine, Anesthesiology and Physiology, Section of Pulmonary and Critical Care Medicine, Dartmouth Medical School

Harold L Manning, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

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