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Lead Toxicity Test

 
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Lead Toxicity Testing

Clinical Use

  • Detect lead exposure and/or toxicity

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Clinical Background

Lead is a cumulative protoplasmic poison that may be ingested, inhaled, or absorbed directly through the skin. Toxic effects are categorized as gastrointestinal, central nervous system, neuromuscular, hematologic, renal, or constitutional. Common symptoms include constipation, anorexia, abdominal pain, weight loss, fatigue, and a characteristic peripheral neuropathy (wrist drop). Severe poisoning may lead to nephropathy, encephalopathy, convulsions, and even death.

Lead poisoning may result from occupational exposure (mining, smelters, sheet metal, battery manufacture, automobile radiator repair, demolition work, alloys, and metal plating). Poisoning may also occur subsequent to exposure to leaded containers, lead clay, glazed pottery, solder, paints, and bullets (wound).

Infants and children aged 9 months to 6 years are particularly susceptible to the effects of lead due to greater gastrointestinal absorption. Lead exposure can lead to irreversible IQ deficits, poor academic achievement, reduced attention span, and hyperactivity.

Method

Atomic absorption spectrometry

Interpretive Information

No safe blood level in children has been identified. Consequently, the Centers of Disease Control and Prevention has adopted a cutpoint of 5 μg/dL as the trigger for follow-up in children (Table). 1

Table. Recommended Follow-up for Various Blood Lead Levels 1,2
Blood Lead (μg/dL) Follow-up
<5 None
5 - 14

Nutritional and environmental education

Follow-up blood lead monitoring

15 - 19

Nutritional and environmental education

Follow-up blood lead monitoring; if level rises or if level stays within this range
≥3 months later, see follow-up for 20 - 44 μg/dL levels

20 - 44
Environmental evaluation and remediation and a medical evaluation; medical intervention may be needed
45 - 69 Medical and environmental interventions including chelation therapy
≥70 Medical emergency treatment

References

  1. Centers for Disease Control and Prevention. CDC response to Advisory Committee on Childhood Lead Poisoning Prevention recommendations in “Low level lead exposure harms children: a renewed call for primary prevention.” Atlanta, GA: US Department of Health and Human Services, CDC; June 7, 2012. http://www.cdc.gov/nceh/lead/acclpp/
    cdc_response_lead_exposure_recs.pdf. Accessed March 5, 2013.

  2. Centers for Disease Control and Prevention. Managing elevated blood lead levels among young children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. Atlanta, GA: Centers for Disease Control and Prevention; 2002. www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm. Accessed March 5, 2013.

CPT Code(s)

83655

Methodology

Inductively Coupled Plasma/Mass Spectrometry (ICP/MS) or Atomic Spectroscopy (AS)

Reference Range(s)

Birth-6 Years <5 mcg/dL
>6 Years <10 mcg/dL
Blood lead levels in the range of 5-9 mcg/dL have been associated with adverse health effects in children aged 6 years and younger. Patient management varies by age and CDC Blood Level Range. Refer to the CDC website regarding Lead Publications/Case Management for recommended interventions.

Clinical Significance

Blood lead is useful in detecting industrial, dietary and accidental exposure to lead and to monitor detoxification therapy. Children are especially susceptible to neurologic damage from lead and acute neurologic toxicity may develop without previous symptoms.


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