Manganese (Serum)

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No Fasting Required

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Measures manganese levels.

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Manganese (Serum) - Comprehensive Medical Test Guide

Why is it done?
- Measures serum manganese levels - a trace mineral essential for bone health, metabolism, immune function, and antioxidant defense through the enzyme manganese superoxide dismutase (MnSOD)
- Diagnose manganese deficiency - characterized by impaired bone formation, growth retardation, skin conditions, and metabolic dysfunction
- Detect manganese toxicity - particularly in occupational settings (welding, mining) or from prolonged parenteral nutrition exposure
- Evaluate patients with neurological symptoms suggestive of manganese-related disease or occupational exposure
- Monitor patients receiving long-term total parenteral nutrition (TPN) or patients with chronic liver disease
- Assess nutritional status in cases of malabsorption, chronic diarrhea, or inadequate dietary intake
Normal Range
- Normal Reference Range: 0.4 to 1.2 μg/dL (7.3 to 21.9 μmol/L) for serum manganese Typical adult levels: 4 to 15 ng/mL (varies slightly by laboratory)
- Units of Measurement: μg/dL (micrograms per deciliter) or μmol/L (micromoles per liter); some laboratories report ng/mL (nanograms per milliliter)
- Low Manganese (Below Normal Range): Indicates manganese deficiency; may result in bone abnormalities, impaired wound healing, altered glucose metabolism, and immune dysfunction
- High Manganese (Above Normal Range): Suggests manganese toxicity or excessive exposure; associated with neurological symptoms resembling Parkinson's disease (manganism)
- Normal Interpretation: Values within the reference range indicate adequate manganese status and appropriate metabolic function; normal levels typically reflect balanced dietary intake and proper absorption
Interpretation
- Manganese Deficiency (Low Levels): Results below 0.4 μg/dL indicate deficiency; associated with impaired collagen formation, poor bone mineralization, stunted growth in children, scaly dermatitis, impaired glucose tolerance, decreased fertility, and weakened immune response. May occur with malabsorption disorders, prolonged antibiotic use, or inadequate dietary intake.
- Manganese Toxicity (High Levels): Results above 1.2 μg/dL suggest toxicity; manifests as manganism (chronic manganese toxicity) with progressive neurological symptoms including tremor, rigidity, bradykinesia, dystonia, emotional disturbances, psychosis, and cognitive decline. Occupational exposure is primary cause.
- Borderline Low (0.4-0.6 μg/dL): May indicate early deficiency or subclinical depletion; requires clinical correlation and consideration of dietary intake and absorption status
- Borderline High (0.9-1.2 μg/dL): May indicate mild elevation; clinical significance depends on exposure history, symptoms, and serial measurements
- Factors Affecting Results: Diet (nuts, whole grains, legumes are high in manganese), occupational exposure, liver function (reduced clearance in hepatic disease), kidney function, medications (iron supplements may affect absorption), hemolysis during blood collection, timing of sample relative to exposure, and laboratory methodology variability
- Clinical Significance: Serum manganese is considered a less reliable indicator than hair or urine manganese for chronic exposure assessment. Serial measurements more informative than single values. Serum levels may not fully reflect tissue manganese stores.
Associated Organs
- Primary Organ Systems: Central nervous system (brain, particularly basal ganglia), skeletal system (bones and cartilage), hepatic system (liver - primary site of manganese metabolism and excretion), pancreas (glucose regulation), immune system
- Conditions Associated with Low Manganese: Celiac disease, Crohn's disease, cystic fibrosis, pancreatic insufficiency, cholestasis (impaired bile flow), chronic diarrhea, osteoporosis, bone dysplasia, impaired wound healing, infertility, glucose intolerance, immune dysfunction, growth retardation in children
- Conditions Associated with High Manganese: Manganism (occupational manganese neurotoxicity), Parkinson's disease-like syndrome, liver disease (cirrhosis, hepatitis - impaired biliary excretion), iron-deficiency anemia (increased manganese absorption), chronic kidney disease, prolonged parenteral nutrition exposure
- Occupational Exposure Settings: Welding (welding fumes), mining, ferroalloy production, battery manufacturing, metal smelting, fungicide/pesticide manufacturing
- Complications of Abnormal Levels: Deficiency complications: progressive bone disease, impaired immune function, metabolic dysfunction, reproductive issues; Toxicity complications: irreversible neurological damage (particularly basal ganglia), cognitive decline, psychiatric symptoms, motor disorders, potential disability
Follow-up Tests
- For Low Manganese Results: Hair or urine manganese analysis (better markers of chronic status), serum iron and ferritin levels (iron competes with manganese absorption), comprehensive metabolic panel (liver and kidney function), absorption studies if malabsorption suspected, bone mineral density testing if osteoporosis concerns, repeat serum manganese after 4-6 weeks of supplementation
- For High Manganese Results: 24-hour urine manganese (assess current exposure and excretion), hair manganese (chronic exposure indicator), liver function tests and hepatic imaging if elevated (cholestasis increases retention), neurological examination and neuropsychological testing for manganism, MRI brain (particularly T1-weighted imaging showing characteristic basal ganglia changes), occupational history and workplace manganese monitoring
- For Monitoring Ongoing Conditions: TPN patients: serum manganese every 3-6 months; Occupational exposure: baseline and annual serum manganese, periodic neurological assessment; Liver disease: serum manganese with hepatic panel monitoring; Malabsorption disorders: repeat testing after treatment with 6-12 week intervals
- Complementary Investigations: Other trace element panels (zinc, copper, selenium, iron), ceruloplasmin and serum copper (rule out Wilson's disease with neurological symptoms), brain imaging studies, occupational exposure assessment, dietary analysis for manganese intake, gastrointestinal function evaluation if malabsorption suspected
- Additional Tests Based on Clinical Context: Albumin and total protein (serum manganese is bound to proteins), glucose tolerance testing, bone alkaline phosphatase (reflects bone turnover), immune function panel if deficiency affects immunity
Fasting Required?
- Fasting Required: No - Fasting is not required for serum manganese testing; the test can be performed on a random blood sample regardless of meal timing
- Patient Preparation Instructions: Wear comfortable, loose-fitting clothing to facilitate blood draw; continue all regular medications unless specifically instructed otherwise by healthcare provider; arrive well-hydrated but avoid excessive fluid intake immediately before testing
- Medications - No Special Restrictions: Most medications do not need to be held before testing; however, discuss with your healthcare provider if taking iron supplements, tetracyclines, or antacids as these may interfere with manganese absorption (affecting results in the context of chronic therapy, not acute test accuracy)
- Timing Considerations: For occupational exposure assessment, blood draw ideally performed at end of work week to capture accumulated exposure; for supplement monitoring, draw at least 4-6 weeks after starting manganese supplementation
- Pre-Test Recommendations: Maintain normal diet in days before testing (unless specifically instructed for dietary restriction study); provide detailed dietary history including intake of manganese-rich foods (nuts, seeds, whole grains, tea); document occupational exposures and workplace history; list all current supplements and medications; avoid excessive physical exertion immediately before testing
- Sample Collection Notes: Blood sample collected via venipuncture into appropriate collection tube (typically serum separator tube or EDTA tube per laboratory protocol); avoid hemolysis during collection as it can falsely elevate results; sample should be processed promptly and stored according to laboratory guidelines

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