TRACE ELEMENTS IN SERUM

TRACE ELEMENTS IN SERUM Proficiency Test Report Event #, 0 November 6 th, 0

Event #, 0 Serum Aluminum Serum materials were obtained from the Dutch EQA (External Quality Assessment) scheme SKML (Stichting Kwaliteitsbewaking Medische Laboratoria) as part of a global collaborative exercise to harmonize international measurements of Al, Cu, Se and Zn in serum. Additionally, serum pools were spiked with a suite of trace elements (Co, Cr, Li, Mg, Mn, Tl, and V), including aluminum as AlCl at various concentrations. The serum has been tested and found to be negative for BSE (Bovine Spongiform Encephalopathy), and free of pathogens. The Certificate of Analysis provided by SKML is available upon request. The Target Value assigned for each PT material is the robust mean of the results reported by all participants in this event. The robust statistics were obtained utilizing algorithms based on those presented in ISO 58:005E Statistical methods for use in proficiency testing by interlaboratory comparisons. Values for serum aluminum range from µg/l (0.4 µmol/l) to 80 µg/l (6.67 µmol/l). Acceptable ranges for serum aluminum are based on fixed criteria of ±0%, or ±5 µg/l below 5 µg/l. These criteria are based on consensus recommendations from several EQAS organizers (). Discussion. Based on the above criteria, 87.8% of test results reported were judged as satisfactory, with four out of participant laboratories (7.4%) reporting or more of the 5 results outside the acceptable ranges.. Taylor, A., Angerer, J., Claeys, F., Kristiansen, J., Mazarrasa, O., Menditto, A., Patriarca, M., Pineau, A., Schoeters, I., Sykes, C., Valkonen, S. and Weykamp, C. Comparison of procedures for evaluating laboratory performance in external quality assessment schemes for lead in blood and aluminum in serum demonstrates the need for common quality specifications. Clinical Chemistry 00 48 000-007. Trace Elements PT Program www.wadsworth.org/testing/lead/index.htm

Serum Aluminum Test Results, 0 Event # ROBUST STATISTICAL SUMMARY TARGET VALUE ASSIGNMENT AND STATISTICS Results (µg/l serum) SE- SE- SE- SE-4 SE-5 Robust Mean 94 6 80 0 Robust Standard Deviation 9 8 7.5 Standard Uncertainty 0.4 RSD (%) 9.6.5 4.0.6 8. Number of Sample Measurements 0 Acceptable Range: Upper Limit 7 6 6 56 Lower Limit 75 49 44 6 04 notes: Results reported as less than the method detection limit are excluded from statistical calculations.

Serum Aluminum Test Results, 0 Event # PERFORMANCE OF PARTICIPATING LABORATORIES Lab Code Method SE- Results (µg/l serum) SE- SE- SE-4 SE-5 Info Only Target Values: 94 6 80 0 0 ETAAS-Z 0 68 86 0 6 4 ICP-MS 96 89 88 7 47 FAAS 00 65 9 7 Info 56 ICP-MS 99 64 80 < 60 ICP-MS 96 59 86 64 ICP-MS 9 58 75 0 8 79 DRC/CC-ICP-MS 85 54 78 8 6 97 ICP-MS 06 6 78 <0 47 00 DRC/CC-ICP-MS 86 55 79 Info 06 DRC/CC-ICP-MS >00 77 >00 >00 87 ETAAS-Z 89 55 74 9 8 9 ICP-MS 9 69 74 Info 05 ICP-MS 06 66 0 6 4 ICP-MS 9 56 76 7 Info 5 ETAAS-Z 55 69 89 4 Info 55 ICP-MS 87 60 77 0 4 57 ICP-MS 05 74 99 8 58 ICP-MS 9 58 74 0 6 6 ICP-MS 89 56 78 8 5 6 ICP-MS 9 58 80 6 66 ETAAS-Z 7 40 08 0 Info 40 ICP-AES/OES 97 4 65 < Info 458 ETAAS Other 7 6 8 0 65 Percent satisfactory results for all participants: 87.8 % notes: reported outside upper limit Info only: results included for informational purposes only. reported outside lower limit notes: Results reported as less than the method detection limit are excluded from statistical calculations.

DRC/CC-ICP-MS New York State Department of Health Serum Aluminum Test Results, 0 Event # STATISTICAL SUMMARY BY METHOD ETAAS Other ETAAS-Z FAAS ICP-AES/OES ICP-MS All Laboratories Results (µg/l serum) SE- SE- SE- SE-4 SE-5 86 7 4 80 0 5.5 00 97 96 7 6.8 9.5 6 6 4 58 4.4 65 4 64 9 4.5 6 0 7.0 79 8 4 64 8. 9 65 84 4 7.5 79 0.0 0 0 4. 0 0. 0 4. 4 65 4 7 5.9 7 0 8 6. 0 9.6 notes: Insufficient data for calculation.

Event #, 0 Serum Copper Serum materials were obtained from the Dutch EQA (External Quality Assessment) scheme SKML (Stichting Kwaliteitsbewaking Medische Laboratoria) as part of a global collaborative exercise to harmonize international measurements of Al, Cu, Se and Zn in serum. Additionally, serum pools were spiked with a suite of trace elements (Co, Cr, Li, Mg, Mn, Tl, and V), including copper as CuCl at various concentrations. The serum has been tested and found to be negative for BSE (Bovine Spongiform Encephalopathy), and!free of pathogens. The Certificate of Analysis provided by SKML is available upon request. The Target Value assigned for each PT material is the robust mean of the results reported by all participants in this event. The robust statistics were obtained utilizing algorithms based on those presented in ISO 58:005E Statistical methods for use in proficiency testing by interlaboratory comparisons. Values for serum copper range from 675 µg/l (0.6 µmol/l) to 869 µg/l (45.5 µmol/l). Acceptable ranges for serum copper are based on fixed criteria of ±5%, or ±95 µg/l below 65 µg/l. These criteria are consistent with those proposed by the OELM Network of EQAS organizers (, ) for trace elements in serum, and are slightly less stringent than those previously suggested for NYS (±0%). Discussion. Based on the above criteria, 95.0% of test results reported were judged as satisfactory, with two out of 0 participant laboratories (0.0%) reporting or more of the 5 results outside the acceptable ranges.. A. Taylor, J. Angerer, J. Arnaud, F. Claeys, R.L. Jones, O. Mazarrasa, E. Mairiaux, A. Menditto, P.J. Parsons, M. Patriarca, A. Pineau, S. Valkonen, J.-P. Weber and C. Weykamp Accreditation and Quality Assurance 006 440-445.. J. Arnaud, J.-P. Weber, C.W. Weykamp, P.J. Parsons, J. Angerer, E. Mairiaux, O. Mazarrasa, S. Valkonen, A. Menditto, M. Patriarca, and A. Taylor Clinical Chemistry 008 54 89-899. Trace Elements PT Program www.wadsworth.org/testing/lead/index.htm

Serum Copper Test Results, 0 Event # ROBUST STATISTICAL SUMMARY TARGET VALUE ASSIGNMENT AND STATISTICS Results (µg/l serum) SE- SE- SE- SE-4 SE-5 Robust Mean 744 7 869 675 09 Robust Standard Deviation 0 9 6 0 8 Standard Uncertainty 8 6 45 8 9 RSD (%) 5.8 7.0 5.6 4.4 6. Number of Sample Measurements 0 0 0 0 0 Acceptable Range: Upper Limit 006 56 99 776 540 Lower Limit 48 8 49 574 878 notes: Results reported as less than the method detection limit are excluded from statistical calculations.

Serum Copper Test Results, 0 Event # PERFORMANCE OF PARTICIPATING LABORATORIES Lab Code Method SE- Results (µg/l serum) SE- SE- SE-4 SE-5 Info Only Target Values: 744 7 869 675 09 07 DRC/CC-ICP-MS 60 0 870 679 0 Info 0 ICP-MS 8 6 94 697 8 4 ICP-MS 640 80 840 670 050 47 ICP-MS 779 66 897 69 05 Info 56 ICP-AES/OES 80 90 940 695 70 60 ICP-MS 740 0 870 690 0 64 ICP-MS 748 5 77 65 5 79 DRC/CC-ICP-MS 870 40 080 700 00 97 ICP-MS 70 0 880 670 0 00 ICP-MS 89 46 04 74 56 Info 06 ICP-MS 700 0 640 660 980 9 ICP-MS 697 78 75 648 49 Info 05 ICP-MS 490 50 460 570 850 4 ICP-MS 544 57 496 595 9 Info 5 ICP-MS 440 500 70 650 50 Info 59 ICP-MS 79 6 85 644 00 66 ETAAS-Z 84 46 40 680 600 Info 40 DRC/CC-ICP-MS 786 66 885 69 8 Info 457 ICP-AES/OES 766 98 04 707 8 Info 48 ICP-MS 780 4 98 699 09 Percent satisfactory results for all participants: 95.0 % notes: reported outside upper limit Info only: results included for informational purposes only. reported outside lower limit notes: Results reported as less than the method detection limit are excluded from statistical calculations.

DRC/CC-ICP-MS New York State Department of Health Serum Copper Test Results, 0 Event # STATISTICAL SUMMARY BY METHOD ETAAS-Z ICP-AES/OES ICP-MS All Laboratories Results (µg/l serum) SE- SE- SE- SE-4 SE-5 76 84 798 45 4 700 0 7.6 0 76 7. 65 55 46 94 6 4 99 97 7.5 0 5 9 7.0 945 7 40 987 66 4 795 70 6. 0 868 0 7. 69 680 70 8 4 660 4 6.4 0 669 9 5.8 7 9 600 7 80 4 47 5 7. 0 0 7 7.8 notes: Insufficient data for calculation.

Event #, 0 Serum Selenium Serum materials were obtained from the Dutch EQA (External Quality Assessment) scheme SKML (Stichting Kwaliteitsbewaking Medische Laboratoria) as part of a global collaborative exercise to harmonize international measurements of Al, Cu, Se and Zn in serum. Additionally, serum pools were spiked with a suite of trace elements (Co, Cr, Li, Mg, Mn, Tl, and V), including selenium as SeO at various concentrations. The serum has been tested and found to be negative for BSE (Bovine Spongiform Encephalopathy), and free of pathogens. The Certificate of Analysis provided by SKML is available upon request. The Target Value assigned for each PT material is the robust mean of the results reported by all participants in this event. The robust statistics were obtained utilizing algorithms based on those presented in ISO 58:005E Statistical methods for use in proficiency testing by interlaboratory comparisons. Values for serum selenium range from 47 µg/l (0.60 µmol/l) to 68 µg/l (.9 µmol/l). Acceptable ranges for serum selenium are based on fixed criteria of ±0%, or ± µg/l below 0 µg/l. These criteria are a little less stringent than those proposed by the OELM Network of EQAS organizers (±5% or ±8 µg/l below 55 µg/l) (, ) for trace elements in serum. As performance for serum Se improves among NYS-permit laboratories, consideration will be given to adopting the OELM criteria. Discussion. We have become aware of a potential interference on Se in ICP-MS when sera from bovine sources are used for PT sample pools. We are currently investigating this and will report on our findings in due course. Until that time, grading for serum Se is suspended. We ask that participants continue to analyze our serum pools for Se, along with other trace elements, to aid in the investigation. We included human sera for comparison purposes with this PT event (SE- through 5), and we requested participant s cooperation by analyzing these additional materials for Se. We will shortly be circulating a summary of the results, as well as from the questionnaire which asked for more details of the analytical methods used for Se.. A. Taylor, J. Angerer, J. Arnaud, F. Claeys, R.L. Jones, O. Mazarrasa, E. Mairiaux, A. Menditto, P.J. Parsons, M. Patriarca, A. Pineau, S. Valkonen, J.-P. Weber and C. Weykamp Accreditation and Quality Assurance 006 440-445.. J. Arnaud, J.-P. Weber, C.W. Weykamp, P.J. Parsons, J. Angerer, E. Mairiaux, O. Mazarrasa, S. Valkonen, A. Menditto, M. Patriarca, and A. Taylor Clinical Chemistry 008 54 89-899. Trace Elements PT Program www.wadsworth.org/testing/lead/index.htm

Serum Selenium Test Results, 0 Event # ROBUST STATISTICAL SUMMARY TARGET VALUE ASSIGNMENT AND STATISTICS Results (µg/l serum) SE- SE- SE- SE-4 SE-5 Robust Mean 56 99 47 68 5 Robust Standard Deviation 6 0 4 9 8 Standard Uncertainty RSD (%) 4.0 4.9 7.5. 6.7 Number of Sample Measurements 5 5 5 5 5 Acceptable Range: Upper Limit 87 9 56 8 Lower Limit 5 59 8 4 9 notes: Results reported as less than the method detection limit are excluded from statistical calculations.

Serum Selenium Test Results, 0 Event # PERFORMANCE OF PARTICIPATING LABORATORIES Lab Code Method SE- Results (µg/l serum) SE- SE- SE-4 SE-5 Info Only Target Values: 56 99 47 68 5 07 DRC/CC-ICP-MS 4 9 46 57 06 Info 0 DRC/CC-ICP-MS 5 9 4 59 08 4 ICP-MS 5 4 9 68 47 47 DRC/CC-ICP-MS 59 99 49 70 Info 56 ICP-MS 59 9 57 65 7 64 DRC/CC-ICP-MS 57 8 47 8 5 79 DRC/CC-ICP-MS 5 0 45 54 00 DRC/CC-ICP-MS 7 48 95 7 Info 06 DRC/CC-ICP-MS 58 0 5 86 6 9 DRC/CC-ICP-MS 5 98 44 69 Info 05 ICP-MS 58 04 5 68 8 4 ICP-MS 5 98 46 65 Info 66 ETAAS-Z 40 75 6 6 0 Info 67 DRC/CC-ICP-MS 6 08 46 75 Info 40 DRC/CC-ICP-MS 56 06 49 65 Info Percent satisfactory results for all participants: 00.0 % notes: reported outside upper limit Info only: results included for informational purposes only. reported outside lower limit notes: Results reported as less than the method detection limit are excluded from statistical calculations.

DRC/CC-ICP-MS New York State Department of Health Serum Selenium Test Results, 0 Event # STATISTICAL SUMMARY BY METHOD ETAAS-Z ICP-MS All Laboratories Results (µg/l serum) SE- SE- SE- SE-4 SE-5 0 56 8 5.0 40 4 76 9. 5 60.7 0 99 9 4.6 75 4 09 0.4 5 00 5 7.5 0 47 6. 6 5 6 4 47 7 5. 0 7 5.0 6 4 67 0.6 5 69 4. 0 5 7 6. 0 4 6. 5 7 9. notes: Insufficient data for calculation.

Event #, 0 Serum Zinc Serum materials were obtained from the Dutch EQA (External Quality Assessment) scheme SKML (Stichting Kwaliteitsbewaking Medische Laboratoria) as part of a global collaborative exercise to harmonize international measurements of Al, Cu, Se and Zn in serum. Additionally, serum pools were spiked with a suite of trace elements (Co, Cr, Li, Mg, Mn, Tl, and V), including zinc as ZnCl at various concentrations. The serum has been tested and found to be negative for BSE (Bovine Spongiform Encephalopathy), and free of pathogens. The Certificate of Analysis provided by SKML is available upon request. The Target Value assigned for each PT material is the robust mean of the results reported by all participants in this event. The robust statistics were obtained utilizing algorithms based on those presented in ISO 58:005E Statistical methods for use in proficiency testing by interlaboratory comparisons. Values for serum zinc range from 89 µg/l (9.7 µmol/l) to 975 µg/l (45.50 µmol/l). Acceptable ranges for serum zinc are based on fixed criteria of ±5%, or ±5 µg/l below 00 µg/l. These criteria are consistent with those proposed by the OELM network of EQAS organizers () for trace elements in serum. Discussion. Based on the above criteria, 86.7% of test results reported were judged as satisfactory, with four out of 7 participant laboratories (4.8 %) reporting or more of the 5 results outside the acceptable ranges.. A. Taylor, J. Angerer, J. Arnaud, F. Claeys, R.L. Jones, O. Mazarrasa, E. Mairiaux, A. Menditto, P.J. Parsons, M. Patriarca, A. Pineau, S. Valkonen, J.-P. Weber and C. Weykamp Accreditation and Quality Assurance 006 440-445.. J. Arnaud, J.-P. Weber, C.W. Weykamp, P.J. Parsons, J. Angerer, E. Mairiaux, O. Mazarrasa, S. Valkonen, A. Menditto, M. Patriarca, and A. Taylor Clinical Chemistry 008 54 89-899. Trace Elements PT Program www.wadsworth.org/testing/lead/index.htm

Serum Zinc Test Results, 0 Event # ROBUST STATISTICAL SUMMARY TARGET VALUE ASSIGNMENT AND STATISTICS Results (µg/l serum) SE- SE- SE- SE-4 SE-5 Robust Mean 497 89 975 8 Robust Standard Deviation 70 6 00 6 Standard Uncertainty 4 54 4 5 9 RSD (%) 8.0 9. 7.8 7.4 8.9 Number of Sample Measurements 7 7 7 7 7 Acceptable Range: Upper Limit 45 87 48 4 085 Lower Limit 8 096 59 54 notes: Results reported as less than the method detection limit are excluded from statistical calculations.

Serum Zinc Test Results, 0 Event # PERFORMANCE OF PARTICIPATING LABORATORIES Lab Code Method SE- Results (µg/l serum) SE- SE- SE-4 SE-5 Info Only Target Values: 497 89 975 8 07 DRC/CC-ICP-MS 00 400 80 790 660 Info 0 ICP-MS 86 660 64 90 9 4 ICP-MS 980 0 0 680 650 47 ICP-MS 07 7 48 68 967 Info 56 ICP-AES/OES 00 480 60 00 780 60 ICP-MS 980 0 0 870 70 64 ICP-MS 0 488 6 00 79 79 DRC/CC-ICP-MS 50 60 70 40 880 97 ICP-MS 050 440 70 00 740 00 ICP-MS 67 74 9 77 969 Info 06 ICP-MS 080 00 80 950 680 87 FAAS 0 590 90 00 90 9 ICP-MS 065 405 48 95 765 Info 05 ICP-MS 70 00 070 470 480 4 ICP-MS 676 94 08 46 47 Info 5 ICP-MS 90 860 50 690 00 Info 55 ICP-MS 479 9 99 846 57 ICP-MS 050 440 0 80 740 58 ICP-MS 90 560 90 090 880 59 ICP-MS 080 7 9 745 650 6 ICP-MS 080 40 40 890 740 6 ICP-MS 480 950 90 040 070 66 ETAAS-Z 04 90 04 75 700 Info 40 DRC/CC-ICP-MS 77 570 4 067 877 Info 457 ICP-AES/OES 989 586 546 466 59 Info 458 FAAS 68 64 94 58 97 48 ICP-MS 7 576 04 8 Percent satisfactory results for all participants: 86.7 % notes: reported outside upper limit Info only: results included for informational purposes only. reported outside lower limit notes: Results reported as less than the method detection limit are excluded from statistical calculations.

DRC/CC-ICP-MS New York State Department of Health Serum Zinc Test Results, 0 Event # STATISTICAL SUMMARY BY METHOD ETAAS-Z FAAS ICP-AES/OES ICP-MS All Laboratories Results (µg/l serum) SE- SE- SE- SE-4 SE-5 46 04 99 98 545 69 9 095 97 9.4 7 46 45.4 5 9 90 66 6 0 78 9 46 58 0.5 7 57 0. 45 04 4 74 40 0 9 66 8.7 7 86 8.7 999 85 75 79 8 6 9 9 46 8.4 7 00 97. 806 6 700 946 6 87 575 9 786 77 9.9 7 87. notes: Insufficient data for calculation.

Event #, 0 Additional Trace Elements Reported in Serum Participant laboratories reported their analytical results for any additional trace elements (other than Al, Cu, Se and Zn) that are routinely reported so that a more complete characterization can be recorded for these PT materials. Results for additional trace elements are reported here, but no target value is implied nor are any acceptable ranges provided. These data are provided solely for educational and informational purposes. Serum materials were obtained from the Dutch EQA (External Quality Assessment) scheme SKML (Stichting Kwaliteitsbewaking Medische Laboratoria) as part of a global collaborative exercise to harmonize international measurements of Al, Cu, Se and Zn in serum. Additionally, serum pools were spiked with a suite of trace elements at various concentrations including cobalt as CoCl, chromium as CrCl, lithium as LiCl, magnesium as MgCl, manganese as MnCl, thallium as TlNO, and vanadium as VOSO 4. The serum has been tested and found to be negative for BSE (Bovine Spongiform Encephalopathy), and free of pathogens. The Certificate of Analysis provided by SKML is available upon request. Additional Elements Co, Cr, Li, Mg, Mn, Tl, V Trace Elements PT Program www.wadsworth.org/testing/lead/index.htm

Serum Additional Elements, 0 Event # Page Serum Antimony (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 5. 5. 5. 5. 5. 47 ICP-MS 5.7 4.7 5. 5. 6. Serum Arsenic (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 97 DRC/CC-ICP-MS <0.0 <0.0 <0.0 <0.0 <0.0 Serum Barium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS 8.7 9.7 40.5 9.7 40 0 ICP-MS 4. 4. 4. 45. 44.4 97 ICP-MS 4.9 4.4 4.0 4. 40.8 Arithmetic mean 4. 4.4 4.5 4.4 4.7 SD..8.4.7. n Serum Beryllium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS <0.45 <0.45 <0.45 <0.45 <0.45 97 ICP-MS 0. <0. <0. <0. <0. Serum Bismuth (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 97 ICP-MS <.0 <.0 <.0 <.0 <.0 Serum Cadmium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 0. 0. 0. 0. 0. 47 ICP-MS 0. 0.85 0.9 0.75 0. 97 DRC/CC-ICP-MS <0.5 <0.5 <0.5 <0.5 <0.5 4 ICP-MS 0. 0. 0. 0. 0. Arithmetic mean 0.8 0.7 0.7 0.4 0.8 SD 0.05 0.04 0.04 0.04 0.04 n Serum Chromium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 DRC/CC-ICP-MS 4.46.97 8.97 0.4 6. 56 DRC/CC-ICP-MS 4.5.8 8.5 <.0 5.6 64 DRC/CC-ICP-MS 5..0 8.4 0.4 6. 79 DRC/CC-ICP-MS 5.0.9 9. 0. 6.4 97 DRC/CC-ICP-MS 5.8.5 8. <.0 5.6 06 DRC/CC-ICP-MS 4.6. 9.4 <.0 6 05 ICP-MS 5.7.5 *.6 0. 7.6 4 ETAAS-Z 5.. 9.9 0.5 7.0 *Omitted Arithmetic mean 5.0.0 8.9 0.4 6. SD 0.5 0. 0.6 0. 0.7 n 8 8 7 5 8

Serum Additional Elements, 0 Event # Page Serum Cobalt (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 5..8 9.5. 7. 4 ICP-MS 5..8 9.7. 7. 47 ICP-MS 5.9.6 9.78 0.97 7.07 56 DRC/CC-ICP-MS 4.9.4 9. <.0 6.4 64 ICP-MS 5..7 9.9. 6.9 79 DRC/CC-ICP-MS 5.4.7 0.0.0 7. 97 ICP-MS 5.7.9 9.9. 7.5 06 ICP-MS 5.6.5 8.9. 6.7 4 ICP-MS 5.08.48 9.05.06 6.74 Arithmetic mean 5..7 9.5. 7.0 SD 0. 0. 0.4 0. 0. n 9 9 9 8 9 Serum Iodine (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 4 ICP-MS.4 4.7. 6.9 4.4 47 ICP-MS 54 47 5 5 5 64 DRC/CC-ICP-MS 95.0 59.0 86.0 76.0 80.0 79 ICP-MS 50.0 54.0 55.0 54.0 5.0 97 ICP-MS 6.5 5.8 5.5 7.4 7.8 06 ICP-MS 8. 49.6 44. 49.5 40.0 Arithmetic mean 50 46 49 49 49 SD 5 7 8 n 6 6 6 6 6 Serum Iron (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 457 ICP-AES/OES 658 665 645 685 684 Serum Lead (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS 0.698 0.7 0.70 0.75 0.79 97 DRC/CC-ICP-MS 0.6 0.7 0.6 0.6 0.6 Serum Lithium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS 50 485 85 0958 889 Serum Manganese (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 04.0 04.0 0.0 0.0 0.0 4 ICP-MS 0.9.6 94.8 00. 04.8 47 ICP-MS 97. 00 04 00 0 79 DRC/CC-ICP-MS 98.0 0.7 0.4 00. 0.0 97 DRC/CC-ICP-MS *5. 09. 09. 0.9 07. 06 ICP-MS 94.6 95.6 97. 94. 95.6 05 ICP-MS 96.9 94. 94.9 96. 9.8 4 ICP-MS 99.0 98. 99.0 98.7 99.6 *Omitted Arithmetic mean 99 0 0 99 0 SD 7 5 5 n 7 8 8 8 8

Serum Additional Elements, 0 Event # Page Serum Mercury (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS <0. <0. <0. <0. <0. 97 ICP-MS <5.0 <5.0 <5.0 <5.0 <5.0 Serum Molybdenum (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 8.8 8.6 8.4 8.6 9.0 47 ICP-MS 9. 8.85 9.04 9. 9.8 79 ICP-MS 9. 9.8 9.6 9. 9.8 97 ICP-MS.8.6.4.5. Arithmetic mean 9.8 9.7 9.6 9.7 9.8 SD.4.4...0 n 4 4 4 4 4 Serum Nickel (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 4 ICP-MS.4. *..6 *. 47 ICP-MS 0.864 0.87 0.76.07 0.65 79 DRC/CC-ICP-MS 0.7 0.7 0.7 0.8 0.7 97 ICP-MS <.0 <.0 <.0 <.0 <.0 06 ICP-MS <0.0 <0.0 <0.0 <0.0 <0.0 *Omitted Arithmetic mean.7.6 -.8 - SD.5.5 -.5 - n - - Serum Platinum (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 0.4 0.5 0.8 0. 0. 79 ICP-MS <0.0 <0.0 <0.0 <0.0 <0.0 Serum Silver (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS 0. 0. 0.08 0.9 0.4 79 ICP-MS <0. <0. <0. <0. <0. 97 ICP-MS <.0 <.0 <.0 <.0 <.0 Serum Tellurium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS <0.09 <0.09 <0.09 <0.09 <0.09 97 ICP-MS <.0 <.0 <.0 <.0 <.0 Serum Thallium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 5.9 7.8.0 0.5 4.0 47 ICP-MS 4.74 6. 0.697 8.89.0 97 ICP-MS 5. 7.0 <.0 9..6 Arithmetic mean 5. 7.0-9.6.5 SD 0.6 0.8-0.8 0.5 n -

Serum Additional Elements, 0 Event # Page 4 Serum Thorium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS <0.0 <0.0 <0.0 <0.0 <0.0 Serum Tin (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 0 ICP-MS 0.7 0.7 0.7 0.7 0.7 47 ICP-MS 0.74 0.686 0.677 0.76 0.7 97 ICP-MS <5.0 <5.0 <5.0 <5.0 <5.0 Serum Tungsten (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS <0.68 <0.68 <0.68 <0.68 - Serum Uranium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 ICP-MS 0. 0.57 0.6 0.6 0.8 Serum Vanadium (µg/l) Lab Code Method SE- SE- SE- SE-4 SE-5 47 DRC/CC-ICP-MS 5.88 7.66.69 0. 4.7 79 DRC/CC-ICP-MS 5.0 7.0.5 9..9

ATOMIC SPECTROMETRY METHODS New York State Department of Health Trace Elements in Serum METHOD NOTES A- ETAAS-Z (Electrothermal atomic absorption spectrometry with Zeeman background correction) A- ETAAS other (i.e., D, S-H background correction) A- FAAS (Flame atomic absorption spectrometry) A-4 CV-AAS (Cold vapor atomic absorption spectrometry) A-5 HG-AAS (Hydride generation atomic absorption spectrometry) A-6 AFS (Atomic fluorescence spectrometry) A-7 Other INDUCTIVELY COUPLED PLASMA P- ICP-MS (Inductively coupled plasma - mass spectrometry) P- DRC/CC-ICP-MS (ICP-MS used in the Dynamic Reaction Cell or Collision Cell mode) P- ICP-AES/OES (ICP atomic/optical emission spectrometry) P-4 HR-ICP-MS (High resolution ICP-MS) P-5 ETV-ICP-MS (Electrothermal vaporization ICP-MS) P-6 ID-ICP-MS (Isotope dilution ICP-MS) P-7 Other ELECTROCHEMICAL METHODS E- ASV (Anodic stripping voltammetry without digestion) E- ASV-LeadCare (Anodic stripping voltammetry using the ESA LeadCare system) E- Fluoride specific electrode E-4 Other MOLECULAR FLUORIMETRY F- EtOAc (Ethyl acetate-acetic acid extraction method for determination of erythrocyte protoporphyrin) F- Aviv hematofluorometry (for determination of EP at hematocrit 5) F- Helena ZPP (for determination of zinc protoporphyrin in µmol ZPP/mol heme) F-4 Other OTHER METHODS If your method is not listed in the above list, please describe it briefly.