Ordering Recommendation

Recommended for the assessment of industrial lead exposure in adults and provides exposure guidance in accordance with OSHA regulations. To assess lead exposure in a non-occupational setting, Lead, Blood (Venous) (0020098) is preferred.

Mnemonic
LEAD-IND
Methodology

Quantitative Inductively Coupled Plasma-Mass Spectrometry/Hematofluorometry

Performed

Sun-Sat

Reported

1-5 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation

Collect from patient aged 16 years or older.

Collect

Royal blue (K2EDTA or Na2EDTA) or tan (K2EDTA).

Specimen Preparation

Transport 7 mL whole blood (royal blue), (Min: 2 mL) OR Transport 3 mL whole blood (tan) (Min: 2 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Serum. Specimens collected in tubes other than Royal Blue (K2EDTA or Na2EDTA) or tan (K2EDTA). Heparinized, hemolyzed or clotted specimens.

Remarks

Trace Elements requisition form may be required (ARUP form #32990).

Stability

Ambient: 30 hours; Refrigerated: 5 weeks; Frozen: Unacceptable

Reference Interval
Test Number
Components
Reference Interval
  Lead, Industrial, Whole Blood 0-4.9 µg/dL
  Zinc Protoporphyrin, Blood 0-40 µg/dL
  Zinc Protoporphyrin (ZPP) WholeBld Ratio 0-69 µmol ZPP/mol heme

Interpretive Data

Elevated results may be due to skin or collection-related contamination, including the use of a noncertified lead-free collection/transport tube. If contamination concerns exist due to elevated levels of blood lead, confirmation with a second specimen collected in a certified lead-free tube is recommended.

Reference interval and interpretive comments are based on the "Recommendations for Medical Management of Adult Lead Exposure, Environmental Health Perspectives, 2007." Thresholds and time intervals for retesting, medical evaluation, and response vary by state and regulatory body. Actions described by OSHA in 1978 and finalized in 1983 are shown below.  Contact your State Department of Health and/or applicable regulatory agency for specific guidance on medical management recommendations.

"Occupational Safety and Health Standards: Lead (1983). 29 CFR Part 1910.1025 App C"


Action required for workers with Elevated Lead Values OSHA, Occupational Exposure to Lead, 1978
No. of Tests
Lead
Action Required
1 Greater than or equal to 40.0 µg/dL Notification of worker in writing; medical examination of worker and consultation.
3 (average) Greater than or equal to 50.0 µg/dL Removal of worker from job with potential lead exposure.
1 Greater than or equal to 60.0 µg/dL Removal of worker from job with potential lead exposure.
2 Less than 40.0 µg/dL Reinstatement of worker in job with potential lead exposure is based upon symptoms and medical evaluation.
OSHA requirements in effect since 1978 call for the measurement of whole blood lead and zinc protoporphyrins (ZPP) (NCCLS document C42-A, Nov. 1996) to evaluate the occupational exposure to lead. OSHA requires ZPP whole blood testing to be reported in units of µg/dL. For adults, conversion of ZPP units of µg/dL whole blood assumes a hematocrit of 45 percent. Conversion factor: µmol/mol heme x 0.584= µg/dL.

Information sources for reference intervals and interpretive comments provided below include the "CDC Response to the 2012 Advisory Committee on Childhood Lead Poisoning Prevention Report" and the "Recommendations for Medical Management of Adult Lead Exposure, Environmental Health Perspectives, 2007." Thresholds and time intervals for retesting, medical evaluation, and response vary by state and regulatory body. Contact your State Department of Health and/or applicable regulatory agency for specific guidance on medical management recommendations.

Age
Concentration
Comment
All ages 5-9.9 µg/dL Adverse health effects are possible, particularly in children under 6 years of age pregnant women. Discuss health risks associated with continued lead exposure. For children and women who are or may become pregnant, reduce lead exposure.
All ages 10-19.9 µg/dL Reduced lead exposure and increased biological monitoring are recommended.
All ages 20-69.9 µg/dL Removal from lead exposure and prompt medical evaluation are recommended. Consider chelation therapy when concentrations exceed  50 µg/dL and symptoms of lead toxicity are present.
<19 years of age Greater than 44.9 µg/dL Critical.  Immediate medical evaluation is recommended. Consider chelation therapy when symptoms of lead toxicity are present.
≥19 years of age Greater than 69.9 µg/dL Critical.  Immediate medical evaluation is recommended. Consider chelation therapy when symptoms of lead toxicity are present.

Compliance Statement B: For laboratory developed tests not using a RUO kit, and for FDA approved, cleared or 510(k) exempt assays with alterations. This test was developed and its performance characteristics determined by ARUP Laboratories. The U. S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

Note
Hotline History
N/A
Components
Component Test Code* Component Chart Name LOINC
0020606 Zinc Protoporphyrin (ZPP) WholeBld Ratio 29763-0
0020613 Zinc Protoporphyrin, Blood 2895-1
0025015 Lead, Industrial, Whole Blood 77307-7
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • BLL
  • Blood Lead Level
  • Blood Lead Test
  • Lead
  • Lead Exposure
  • Lead, blood
  • Pb
Lead, Industrial Exposure Panel, Adults