Lead, Whole Blood (Adult)

CPT: 83655
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Test Details

Use

Monitor exposure to lead

Methodology

Atomic absorption spectrometry (AAS) or inductively coupled plasma/mass spectrometry (ICP/MS)

Reference Interval

Environmental exposure (WHO): 0−19 μg/dL

Occupational exposure: BEI® (sampling time is not critical): 30 μg/dL;1 OSHA Lead Standard: 40 μg/dL

Additional Information

Hematologic consequences ascribed to lead toxicity may be basophilic stippling, mild anemia, and reticulocytosis. Other characteristics of toxicity may include increased urine δ-aminolevulinic acid, increased erythrocyte protoporphyrins, and decreased aminolevulinic acid dehydrase. Lead lines on gums or at the metaphyses of long bones in children may also be present.2 Early symptoms of lead poisoning include anorexia, apathy or irritability, fatigue, and anemia.3 Toxic effects include GI distress, joint pain, colic, headache, stupor, convulsions, and coma. Another test that may be used to evaluate lead intoxication is free erythrocyte protoporphyrin (FEP); however, a blood lead assay is the definitive test.4

Lead and organic lead compounds have numerous commercial and industrial applications, including paints, plastics, storage batteries, bearing alloys, insecticides, and ceramics. Exposure may also occur through the inhalation of dust containing lead emitted by automobile exhaust. A common source of lead exposure among children is through the mouthing of inanimate objects, specifically objects with paint and paint chips that contain lead. Acute lead exposure is rare; however, toxicity may occur through acute ingestion of a lead salt or acetate. Blood is the preferred specimen by which the extent of an acute or recent exposure to lead may be measured.

BEI® are reference values intended as guidelines for evaluation of occupational exposure. BEI® represent biological levels of chemicals that correspond to workers with inhalation exposure equivalent to the threshold limit value (TLV®) of the chemicals. TLVs refer to the airborne concentrations of substances and represent conditions under which it is believed that nearly all workers may be repeatedly exposed, day after day, without adverse health effects.1

Specimen Requirements

Specimen

Whole blood

Volume

7 mL

Minimum Volume

0.5 mL

Container

Royal blue-top (EDTA) tube or tan-top lead-free tube; submit original tube.

Collection

Sampling time is not critical for industrial exposure monitoring. Metals with timing “not critical” have very long elimination half-lives and accumulate in the body over years, some for a lifetime. After a couple of weeks of exposure, specimens can be collected at any time.

Storage Instructions

Maintain specimen at room temperature.

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Clotted specimen

Clinical Information

Footnotes

1. TLVs and BEIs, Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices 2010, American Conference of Governmental Industrial Hygienists (ACGIH).
2. Tsalev DL, Zaprianov ZK. Atomic Absorption Spectrometry in Occupational and Environmental Health Practice. Boca Raton, Fla: CRC Press;1983-1984.
3. Baselt RC. Biological Monitoring Methods for Industrial Chemicals. 2nd ed. Littleton, Mass: PSG Publishing Co; 1988.
4. Carson BL, Ellis HV III, McCann JL. Toxicology and Biological Monitoring of Metals in Humans: Including Feasibility and Need. Chelsea, Mich: Lewis Publishers;1986.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
007625 Lead, Blood (Adult) 5671-3 007631 Lead, Blood (Adult) ug/dL 5671-3

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The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf