The pitfalls of hair analysis for toxicants in clinical practice: three case reports.

Abstract

ArticlesHair analysis is used to assess exposure to heavy metals in patients presenting with nonspecific symptoms and is a commonly used procedure in patients referred to our clinic. We are frequently called on to evaluate patients who have health-related concerns as a result of hair analysis. Three patients first presented to outside physicians with nonspecific, multisystemic symptoms. A panel of analytes was measured in hair, and one or more values were interpreted as elevated. As a result of the hair analysis and other unconventional diagnostic tests, the patients presented to us believing they suffered from metal toxicity. In this paper we review the clinical efficacy of this procedure within the context of a patient population with somatic disorders and no clear risk factors for metal intoxication. We also review limitations of hair analysis in this setting; these limitations include patient factors such as low pretest probability of disease and test factors such as the lack of validation of analytic techniques, the inability to discern between exogenous contaminants and endogenous toxicants in hair, the variability of analytic procedures, low interlaboratory reliability, and the increased likelihood of false positive test results in the measurement of panels of analytes.

Hair Trace Elements Concentration to Describe Polymetallic Mining Waste Exposure in Bolivian Altiplano

“…Other difficulties come from the absence of reliable background reference ranges for the different populations due to lack of reproducibility. These limitations are of critical relevance when hair is used to assess individual exposure to contaminants or to assess nutritional status [25][26][27].…”

Consensus document on the prevention of methylmercury exposure in Spain

“…Hair analysis, albeit adequate for measuring MeHg, has limitations and thus should not be relied on to diagnose and even less so to begin unnecessary and potentially dangerous treatments [93][94][95]. The most appropriate manner of proceeding with a patient with suspected mercury poisoning is to collect blood and urine.…”

Hair analysis: exploring the state of the science.

“…Many of these laboratories advertise their ability to identify in hair samples harmful levels of toxic substances and deficiencies of essential nutrients. The recently published case reports about the pitfalls of hair analysis (Frisch and Schwartz 2002) are similar to the experiences ATSDR has encountered, one of which served as an impetus for convening the expert panel (ATSDR 2001). In accordance with its mission, the agency wants to use the best science to provide trusted health information to concerned communities and individuals.…”