Manganese (Blood)

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Measures manganese levels.

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Manganese (Blood) - Comprehensive Medical Test Guide

Section 1: Why is it done?
- Test Purpose: Measures blood manganese levels to assess for manganese toxicity or deficiency. Manganese is an essential trace mineral required for bone development, metabolism, and nervous system function.
- Primary Indications: Suspected manganese toxicity from occupational exposure (welding, mining), evaluation of chronic liver disease, assessment of manganese-related neurological symptoms (Parkinsonism), monitoring of total parenteral nutrition (TPN), evaluation of bone metabolism disorders, and diagnosis of manganese deficiency.
- Clinical Scenarios: Workers with prolonged inhalation exposure to manganese dust, patients on long-term parenteral nutrition, individuals with hepatic dysfunction, those presenting with movement disorders of unknown etiology, patients with unusual seizure patterns, or workers in steel, battery, or chemical manufacturing industries.
Section 2: Normal Range
- Reference Range: 0.4 - 0.85 μg/dL (micrograms per deciliter) or 4 - 8.5 μg/L (micrograms per liter). Normal ranges may vary slightly between laboratories depending on methodology and population studied.
- Interpretation of Results: LOW LEVELS (below 0.4 μg/dL): Manganese deficiency, indicating inadequate intake or absorption, potentially affecting bone health and metabolism. NORMAL LEVELS: Adequate manganese status with appropriate body stores and no evidence of toxicity. HIGH LEVELS (above 0.85 μg/dL): Manganese accumulation suggesting occupational or environmental exposure, potential neurotoxicity, or impaired elimination mechanisms.
- Units of Measurement: Micrograms per deciliter (μg/dL) or micrograms per liter (μg/L). One μg/dL equals 10 μg/L.
- Clinical Significance: Normal results do not exclude manganese toxicity if symptoms are present, as blood levels may not reflect tissue accumulation. Elevated serum levels combined with clinical symptoms suggest active manganese exposure or toxicity requiring intervention.
Section 3: Interpretation
- Elevated Manganese Levels: Indicates exposure from occupational sources (welding fumes, mining dust), environmental contamination, or impaired hepatic clearance. Associated with manganism (chronic manganese toxicity) characterized by progressive neurological deterioration, Parkinson-like symptoms (rigidity, bradykinesia, tremor), psychiatric changes (irritability, mood disturbances), and cognitive decline. Severity correlates with duration and intensity of exposure.
- Low Manganese Levels: Suggests manganese deficiency from inadequate dietary intake, malabsorption disorders, or excessive loss. May contribute to poor bone quality, impaired carbohydrate metabolism, reduced immune function, and growth abnormalities in children. Can occur with restrictive diets or severe gastrointestinal disease.
- Factors Affecting Results: Occupational exposure history, dietary manganese intake (tea, nuts, whole grains contain high amounts), liver function status, renal disease, recent blood transfusions, hemolysis during collection, time of sampling (levels may fluctuate), medications affecting absorption, and individual genetic variations in manganese metabolism.
- Clinical Correlation Essential: Blood manganese reflects recent exposure; hair and urine levels may provide additional information about chronic exposure. Tissue accumulation (particularly in basal ganglia) may not correlate with serum levels. Serial measurements may be more informative than single values for monitoring exposure trends.
Section 4: Associated Organs
- Primary Organ Systems: Central Nervous System (CNS): Primary target organ for manganese toxicity. Accumulates in basal ganglia causing progressive neurodegenerative changes. Liver: Critical for manganese metabolism and elimination via biliary excretion; hepatic disease impairs clearance. Bone: Manganese essential for osteoblast function and bone mineralization.
- Associated Diseases & Conditions: Manganism (occupational manganese poisoning), Parkinson-like syndrome, cirrhosis and chronic liver disease, cholestasis, hepatic encephalopathy, osteoporosis/osteopenia, bone dysplasia, seizure disorders, psychiatric illness, carpal tunnel syndrome, and neurobehavioral dysfunction.
- Neurological Complications: Manganese toxicity causes irreversible neurotoxic effects including action tremor, rigidity, postural instability, gait disturbances, memory impairment, attention deficit, emotional lability, aggressive behavior, and progressive cognitive decline. Early recognition critical as neurological damage may be irreversible once established.
- Hepatic Implications: Cirrhotic patients show elevated serum manganese due to impaired biliary excretion. This contributes to hepatic encephalopathy severity. Cirrhosis screening recommended in workers with manganese exposure and neurological symptoms.
Section 5: Follow-up Tests
- If Elevated Manganese: Liver function tests (ALT, AST, bilirubin, albumin), hepatitis serology, MRI brain (T1-weighted imaging showing basal ganglia hyperintensity), neuropsychological testing, Unified Parkinson's Disease Rating Scale (UPDRS) assessment, urine manganese, hair manganese analysis, occupational history documentation, and neurological examination.
- If Low Manganese: Nutritional status evaluation, bone density studies (DEXA scan), alkaline phosphatase and other bone markers, assessment of gastrointestinal absorption (consider celiac panel, assess for tropical sprue), dietary consultation, and evaluation of malabsorption syndromes.
- Complementary Testing: Other trace minerals (iron, zinc, copper, chromium), complete metabolic panel, complete blood count, ceruloplasmin (to rule out Wilson's disease), 24-hour urine manganese, fecal manganese, and occupational exposure assessment.
- Monitoring Frequency: Workers with occupational exposure: Annual or biannual screening. Patients on TPN: Monthly during therapy initiation, then quarterly. Patients with elevated levels: Repeat testing at 3-6 month intervals to monitor progression and response to intervention. Post-exposure discontinuation: Follow-up at 1, 3, and 6 months.
Section 6: Fasting Required?
- Fasting Status: NO, fasting is NOT required for blood manganese testing. The test can be performed at any time of day regardless of meals.
- Sample Collection Requirements: Blood drawn via venipuncture into trace element-free collection tubes (usually EDTA tube or specific manganese tubes provided by laboratory). Avoid hemolysis as this can falsely elevate results. Proper chain of custody and labeling essential.
- Pre-Test Instructions: No special preparation needed. Patient can eat and drink normally. Should not apply lotions or oils to arm before collection. Inform phlebotomist of any occupational exposures or recent dietary supplements.
- Medications & Supplements: No medications need to be discontinued. However, document use of manganese-containing supplements, multivitamins with manganese, herbal supplements, or TPN formulations. Some medications and supplements may affect results or clinical interpretation.
- Timing Considerations: For occupational exposure assessment, collect samples after several days of exposure or at end of work week. Avoid collection immediately after high dietary manganese intake (e.g., after consuming manganese-rich nuts or tea). Allow several hours after any IV infusions before collection.

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