Due to nationwide shortages of some phlebotomy tubes specified for trace element testing, ARUP Laboratories is currently accepting lavender (EDTA) tubes.

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 Less than or equal to 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 CDC's "Childhood Lead Poisoning Prevention: Recommended Actions Based on Blood Lead Level" and the "Adult Blood Lead Epidemiology and Surveillance: Reference Blood Lead Levels (BLLs) for Adults in the U.S." 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.


Concentration Comment
5-19.9 µg/dL Medical removal is recommended for pregnant women or those who are trying or may become pregnant. Adverse health effects are possible. Reduced lead exposure and increased blood lead monitoring are recommended.
20-69.9 µg/dL Adverse health effects are indicated. Medical removal from lead exposure is required by OSHA if blood lead level exceeds 50 µg/dL. Prompt medical evaluation is recommended.
Greater than 69.9 µg/dL Critical. Immediate medical evaluation is recommended. Consider chelation therapy when symptoms of lead toxicity are present.

"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 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.

Compliance Category

Laboratory Developed Test (LDT)

Note

Hotline History

N/A

CPT Codes

83655; 84202

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