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Lab Manual for Moffitt-Long and Mount Zion

Lab Manual for SFGH

Internal Resources

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Lead, blood

Item Value
Approval req'd? No
Available Stat? No
Test code LEAD
Test group Lead
Performed by China Basin Chemistry
In House Availability Set up Monday reported on Tuesday by 1600
Method Anode stripping voltammetry
Collection Instructions If patient is being treated with Succimer, indicate that on requisition and request: Lead via alternate method, to Quest"

Click here for detailed instructions for collecting samples for Trace Metals
Container type Lavender top (Navy blue top acceptable)
Amount to Collect 2 mL blood
Sample type EDTA whole blood
Preferred volume 2 mL blood
Min. Volume 0.3 mL blood
Processing notes Do NOT centrifuge or transfer to another container. Refrigerate sample. If the patient is being treated with Succimer and requires testing by an alternate method, refer the uncentrifuged, unopened specimen to Quest-Nichols. Order Quest # 56713P
Units µg/dL
Normal range < 5 µg/dL

Source of reference ranges:
The Fourth National Report on Human Exposure to Environmental Chemicals, Updated Tables, September 2012, Department of Health and Human Services (based on NHANES 2009- 2010)

California Management Guidelines on Childhood Lead Poisoning for Health Care Providers
http://www.cdph.ca.gov/programs/CLPPB/Pages/ScreenRegs-CLPPB.aspx

For OSHA guidelines on monitoring lead levels in the workplace and for information on lead levels that require removal of an employee from work (workplace exposure to lead), see http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10030
Synonyms Pb; heavy metal toxicity; heavy metal poisoning; heavy metals
Turn around times 1-8 days
Additional information For treatment guidelines in children based on blood lead levels: Click here

For treatment guidelines in adults based on blood lead levels, see: www.uptodate.com
This test method is NOT suitable for patients receiving treatment with Succimer [DMSA} or D-Penicillamine; contact the laboratory to arrange testing by an alternate method [AAS].

To convert µg/dL to µmol/L (SI units) multiply by 0.0483.

Capillary specimens for lead are easily contaminated. Capillary specimens are acceptable for screening but all retests on BLLs ≥ 10 mcg/dL should be on venous blood. When a reference is made to a "venous" specimen, arterial or umbilical line specimens may be substituted. Use of a heelstick instead of a fingerstick to obtain a capillary specimen is recommended in children under one year of age.

Consider retesting in six months, particularly if the BLL is approaching 10 mcg/dL and the child is less than two years of age, is at high risk for lead exposure, or was tested at the start of warm weather (when BLLs tend to increase).

Initiation of chelation therapy:

Adults:

According to UpToDate (www.uptodate.com), "chelation in adults should generally be initiated for individuals with blood lead levels greater than 100 mcg/dL (4.83 micromol/L), and should also be considered for levels between 80 to 100 mcg/dL in asymptomatic individuals and for blood lead levels between 50 to 80 mcg/dL (2.41 to 3.86 micromol/L) in individuals with lead-related symptoms. In addition, chelation is sometimes considered in persons with even lower blood lead levels [eg, ≥ 40 mcg/dL (1.93 micromol/L)] if they have continued symptoms and elevated blood lead levels after two weeks of removal from exposure. Two chelating agents most commonly used to treat adults are DMSA and CaEDTA. Chelation with any agent should not be undertaken unless exposure has been definitively curtailed, since its use in the presence of continuing exposure may result in enhanced absorption of lead and worsening, rather than amelioration of toxicity. "

Children: see California Management Guidelines on Childhood Lead Poisoning for Health Care Providers: Click here


All blood lead results are electronically sent to the California Department of Health Services weekly.

In addition, all blood lead results on patients less than 18 years of age who reside in the City and County of San Francisco, California are faxed weekly to the San Francisco City and County Department of Public Health - Childhood Lead Poisoning Program.
CPT coding 83655-90
LOINC code 5671-3
Last Updated 11/12/2013 3:44:35 PM
Entry Number 595

If you have additional questions regarding this test, please call: 415-353-1667

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