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HelpTest Code PBPFD Lead Profile Occupational Exposure, Blood
Ordering Guidance
This test is only for assessment of occupational exposure to lead. The preferred test for lead toxicity in children is blood lead. For more information see:
-PBDV / Lead, Venous, with Demographics, Blood
-PBDC / Lead, Capillary, with Demographics, Blood
The preferred screening test for suspicion of a hepatic porphyria is urine porphyrins. For more information see PQNRU / Porphyrins, Quantitative, Random, Urine.
Necessary Information
Include a list of medications the patient is currently taking.
Specimen Required
Both EDTA whole blood and heparin whole blood specimens are required.
Patient Preparation:
1. High concentrations of gadolinium and iodine are known to interfere with most inductively couple plasma mass spectrometry-based metal tests. If either gadolinium- or iodine-containing contrast media has been administered, a specimen should not be collected for 96 hours.
2. Patient should abstain from alcohol for 24 hours prior to specimen collection.
Specimen Type: Whole blood
Supplies:
-Metal Free B-D Tube (EDTA), 6 mL (T183)
-Metal Free B-D Tube (EDTA), 3 mL (T989)
-Microtainer (EDTA) Tube, 0.5 mL (T174)
Container/Tube:
Preferred: Royal blue-top BD Vacutainer Plus with EDTA blood collection tube (6 mL) (BD catalog no. 368381)
Acceptable: Royal blue-top BD vacutainer with EDTA blood collection tube (3 mL), BD Microtainer with EDTA, or royal blue-top Monoject trace element blood collection tube
Specimen Volume: 2 mL
Collection Instructions:
1. See Metal Analysis Specimen Collection and Transport for complete instructions.
2. Send whole blood specimen in original tube. Do not aliquot.
3. Refrigerate specimen as soon as possible.
Specimen Type: Whole blood
Container/Tube:
Preferred: Green top (sodium heparin)
Acceptable: Dark blue top (metal free heparin), green top (lithium heparin), or lavender top (EDTA)
Specimen Volume: 4 mL
Collection Instructions: Refrigerate specimen as soon as possible after collection.
Forms
Useful For
Detecting lead toxicity due to occupational exposure
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| PBB | Lead, B | Yes, (order PBDV) | Yes |
| PPFE | Protoporphyrins, Fractionation, WB | Yes | Yes |
| DEMO5 | Patient Demographics | No | Yes |
Special Instructions
Method Name
PBB: Inductively Coupled Plasma Mass Spectrometry (ICP-MS)
PPFE: High-Performance Liquid Chromatography (HPLC) with Fluorescence Detection
Reporting Name
Lead Profile Occ Exposure, BSpecimen Type
Whole bloodSpecimen Minimum Volume
See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole blood | Refrigerated | 7 days |
Reference Values
LEAD: <3.5 mcg/dL
The Occupational Safety and Health Administration (OSHA) recommended limit for blood lead level is 40 mcg/dL (OSHA 1978).
The biological exposure index (BEI) for Pb in blood of exposed workers is 20 mcg/dL (ACGIH 2018).
Critical Values:
Pediatrics (≤15 years): ≥20.0 mcg/dL
Adults (≥16 years): ≥70.0 mcg/dL
PROTOPORPHYRINS, FRACTIONATION
Free Protoporphyrin: <20 mcg/dL
Zinc-Complexed Protoporphyrin: <60 mcg/dL
Interpretation
The Centers for Disease Control and Prevention (CDC) has identified the blood lead test as the preferred test for detecting lead exposure. The most recent National Health and Nutrition Examination Survey (NHANES) data show that 97.5 percentile for blood lead levels in US adults 16 years and older is 3.46 mcg/dL. In concurrence with the reference value concept that there is no safe level of lead in blood, the Council of State and Territorial Epidemiologists Occupational Health Subcommittee approved lowering the blood lead threshold from 5 mcg/dL to 3.5 mcg/dL for adults. For children younger than 6 years, the current reference level at which the CDC recommends public health actions be initiated is 3.5 mcg/dL. Chelation therapy is indicated when whole blood lead concentration is above 25 mcg/dL in children or above 45 mcg/dL in adults.
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:
|
Number of tests performed |
Whole blood lead concentration |
Action required |
|
1 |
≥40Â mcg/dL |
Notification of worker in writing; medical examination of worker and consultation. |
|
3 (average) |
≥50Â mcg/dL |
Removal of worker from job with potential lead exposure. |
|
1 |
≥60Â mcg/dL |
Removal of worker from job with potential lead exposure. |
|
2 |
<40Â mcg/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 protoporphyrin (CLSI document C42-A, November 1996) to evaluate the occupational exposure to lead.
Elevated zinc protoporphyrin levels in adults may indicate long-term (chronic) lead exposure or may be indicative of iron deficiency anemia or anemia of chronic disease.
Clinical Reference
1. Centers for Disease Control and Prevention. National Report on Human Exposure to Environmental Chemicals. CDC; Updated September 2023. Accessed December 5, 2023. Available at www.cdc.gov/exposurereport
2. Occupational Safety and Health Administration. Medical surveillance guidelines. Occupational Health and Safety Standards Toxic and Hazardous Substances from 1910.1025 App C. OSHA; 2001. Accessed December 5, 2023. Available at https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1025AppC
3. de Burbure C, Buchet J-P, Leroyer A, et al. Renal and neurologic effects of cadmium, lead, mercury, and arsenic in children: evidence of early effects and multiple interactions at environmental exposure levels. Environ Health Perspect. 2006;114(4):584-590
4. Kosnett MJ, Wedeen RP, Rothenberg SJ, et al. Recommendations for medical management of adult lead exposure. Environ Health Perspect. 2007;115(3):463-471
5. Jusko T, Henderson C, Lanphear B, et al. Blood lead concentrations <10 mcg/dL and child intelligence at 6 years of age. Environ Health Perspect. 2008;116(2):243-248
Day(s) Performed
Monday, Wednesday, Friday
Report Available
2 to 6 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83655
82542
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PBPFD | Lead Profile Occ Exposure, B | 29588-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| VECP | Venous/Capillary | 31208-2 |
| 8602 | Lead, B | 77307-7 |
| 2327 | Zinc-Complexed Protoporphyrin | 2895-1 |
| 2326 | Free Protoporphyrin | 94491-8 |
| PTADD | Patient Street Address | 56799-0 |
| PTCIT | Patient City | 68997-6 |
| 29511 | Interpretation | 59462-2 |
| PTSTA | Patient State | 46499-0 |
| PTZIP | Patient Zip Code | 45401-7 |
| PTCNT | Patient County | 87721-7 |
| PTPHO | Patient Home Phone | 42077-8 |
| PTRAC | Patient Race | 32624-9 |
| PTETH | Patient Ethnicity | 69490-1 |
| PTOCC | Patient Occupation | 11341-5 |
| PTEMP | Patient Employer | 80427-8 |
| GDFN | Guardian First Name | 79183-0 |
| GDLN | Guardian Last Name | 79184-8 |
| MDORD | Health Care Provider Name | 52526-1 |
| MDADD | Health Care Provider Street Address | 74221-3 |
| MDCIT | Health Care Provider City | 52531-1 |
| MDSTA | Health Care Provider State | 52532-9 |
| MDZIP | Health Care Provider Zip Code | 87720-9 |
| MDPHO | Health Care Provider Phone | 68340-9 |
| LABPH | Submitting Laboratory Phone | 65651-2 |