The elemental analysis in disease diagnosis and biomedicine screening generally aims at alleviating the difficulties of sample pretreatment techniques, elucidating the distribution and speciation information of elements in bio-samples as well as elevating resolution of multidimensional elemental profiling. The integration of microfluidic techniques with inductively coupled plasma mass spectrometry (ICP-MS) has been demonstrated to possess great potential in these aspects due to the versatile microstructure design, rapid sample pretreatment, extremely low sample consumption, and high-sensitivity/high-throughput elemental detection capability. Herein, an overview of the advancements in microfluidic-based ICP-MS for precise biological elemental determination is provided. A few microfluidic approaches for multiplex and effective manipulation of clinical samples followed by detection with ICP-MS are highlighted, that is, high spatiotemporal resolution sampling, high-purity elemental microextraction device, and high signal-to-noise ratio elemental analysis. In addition, other front-end techniques are discussed for converting various types of samples into a suitable form for detection, for example, laser ablation and time of flight MS. The opportunities and outstanding challenges of microfluidic-based ICP-MS elemental investigations in clinical diagnosis and biomedical studies are also depicted.