From the Guidelines
To check manganese levels, whole blood or RBC concentrations should be measured in patients at-risk of manganese toxicity, as recommended by the most recent guidelines. This approach is supported by the espen micronutrient guideline published in Clinical Nutrition in 2022 1. The guideline suggests that whole blood or RBC concentrations are the preferred measures for assessing manganese levels, with a strong consensus of 94%.
Measurement Methods
Total manganese can be measured in whole blood, RBC, plasma, serum, or urine, preferably by ICP-MS, or by atomic absorption spectroscopy 1. It's essential to note that the majority of circulating manganese is within erythrocytes, making RBC/whole blood manganese an important measure.
Diagnostic Approaches
In addition to blood tests, brain MRI may contribute to confirming the diagnosis of manganese toxicity, showing high intensity signals in globus pallidus correlated with elevated manganese levels, with a strong consensus of 97% 1. Manganism (toxicity) is diagnosed on whole blood manganese, and by neuroimaging 1.
Treatment Thresholds
Whole blood or serum manganese values greater than twice the upper limit of normal laboratory reference ranges should be treated, according to the espen micronutrient guideline with a consensus of 88% 1. It's crucial to consult a healthcare provider to determine the appropriate testing and treatment based on individual symptoms and medical history.
From the Research
Checking Manganese Levels
To check manganese levels, the following methods can be employed:
- Whole-blood manganese levels can be measured using Zeeman-effect flameless atomic absorption spectroscopy, as described in 2
- This method involves diluting the blood specimen in Triton X-100 and using the method of standard additions for quantitation
- The normal whole-blood manganese levels are between 73-219 nmol/L, as observed in 3
- Elevated levels of manganese can be detected using this method, with coefficients of variation ranging from 5.3% to 10.3% for serum manganese and 5.5% to 7.0% for whole-blood manganese, as reported in 2
Measurement Techniques
The measurement techniques for manganese levels include:
- Zeeman-effect flameless atomic absorption spectroscopy, which has a detection limit of 3.0 pg for manganese, as stated in 2
- This technique can be used to determine manganese concentrations in whole blood and serum, with mean concentrations of 9.03 micrograms/L and 1.82 micrograms/L, respectively, as found in 2
Clinical Significance
The clinical significance of checking manganese levels lies in the potential for manganese toxicity, which can occur as a complication of home parenteral nutrition (HPN), as noted in 3
- Elevated manganese levels can lead to Parkinson disease-like symptoms, highlighting the importance of monitoring manganese levels in patients receiving HPN, as discussed in 3