Clinical use: Manganese (Mn) testing is used to evaluate central nervous system symptoms similar to Parkinson disease in workers handling Mn compounds in mining and industry and also for characterization of liver cirrhosis. It can also be used in evaluation of Behcet disease. Manganese deficiency in humans is rare.
Background: Manganese is a trace element that is an essential cofactor for several enzymes. Manganese ores and alloys are refined and used in the making of batteries, welding rods, and high-temperature refractory materials. Environmental exposure occurs from inhalation and ingestion of manganese-containing dust and fumes occurring from the refinement processes. It is likely that inhaled Manganese is mobilized up the trachea and swallowed; uptake through the gut is inefficient, about 10%.Environmental sources of Mn can lead to toxicity. The primary sites of toxicity are the central nervous system (CNS) and the liver. Acute exposure to Mn fumes gives rise to symptoms common to many metal exposures including fever, dry mouth, and muscle pain. Chronic exposure of several months or more gives rise to CNS symptoms and rigidity, with increased scores on tremor testing and depression scales, as well as generalized parkinsonian features

The major compartment for circulating Mn is the erythrocytes, bound to haemoglobin, with whole blood concentrations of Mn being 10 times that of the serum. Mn passes from the blood to the tissues quickly. The half-life of Mn in the body is about 40 days, with elimination primarily through the faeces. Only small amounts are excreted in the urine.

For monitoring therapy, whether following environmental exposure, TPN, or cirrhosis, whole blood levels have been shown to correlate well with neuropsychological improvement, although whether the laboratory changes precede the CNS or merely track with them is unclear as yet

Reference ranges: Blood: 73 – 210 nmol/L (120 – 325 for < 1 year old)
Serum: 9 – 24 nmol/L (not the best sample as liable to get contamination)
Urine: 2 – 27 nmol/L
Associated diseases:
Patient preparation: Prone to contamination from environmental manganese when taking sample. Use plastic cannula for taking sample if possible. If must use metal needle discard first part of sample.
Specimen requirements: Whole blood – EDTA Trace Element Vacutainer (available from JCUH Biochemistry lab) tube is required. Serum sample in an SST is NOT suitable.
Urine: Sample in a plain plastic universal.
Turnaround time: 1 week
Additional information:
Referred test: Referred test
Location: Trace Element Laboratory