Test Id : PBPFD
Lead Profile Occupational Exposure, Blood
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting lead toxicity due to occupational exposure
Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| 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 |
Method Name
A short description of the method used to perform the test
PBB: Inductively Coupled Plasma Mass Spectrometry (ICP-MS)
PPFE: High-Performance Liquid Chromatography (HPLC) with Fluorescence Detection
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Exposure
Lead (Pb)
Pb (Lead)
Specimen Type
Describes the specimen type validated for testing
Whole 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.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| VECP | Venous/Capillary | |
| PTADD | Patient Street Address | |
| PTCIT | Patient City | |
| PTSTA | Patient State | |
| PTZIP | Patient Zip Code | |
| PTCNT | Patient County | |
| PTPHO | Patient Home Phone | |
| PTRAC | Patient Race | |
| PTETH | Patient Ethnicity | |
| PTOCC | Patient Occupation | |
| PTEMP | Patient Employer | |
| GDFN | Guardian First Name | |
| GDLN | Guardian Last Name | |
| MDORD | Health Care Provider Name | |
| MDADD | Health Care Provider Street Address | |
| MDCIT | Health Care Provider City | |
| MDSTA | Health Care Provider State | |
| MDZIP | Health Care Provider Zip Code | |
| MDPHO | Health Care Provider Phone | |
| LABPH | Submitting Laboratory Phone |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Both EDTA whole blood and heparin whole blood specimens are required.
Patient Preparation:
1. High concentrations of gadolinium and iodine are known to potentially 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: EDTA Whole blood
Supplies:
-Metal Free B-D Tube (EDTA), 6 mL (T183)
-Metal Free EDTA 3 mL Tube (T989)
-Microtainer (EDTA) Tube, 0.5 mL (T174)
Container/Tube:
Preferred: Royal blue-top BD vacutainer with EDTA blood collection tube (3 mL) (BD catalog no. 36777) (T989)
Acceptable: Royal blue-top BD Vacutainer Plus with EDTA blood collection tube (6 mL) (BD catalog no. 368381) (T183) or BD Microtainer with EDTA (0.5 mL) (T174)
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 after collection.
Specimen Type: Heparin 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.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
See Specimen Required
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Clotted blood | Reject |
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole blood | Refrigerated | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting lead toxicity due to occupational exposure
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Lead is a heavy metal commonly found in man's environment that can be an acute and chronic toxin.
Lead was banned from household paints in 1978 but is still found in paint produced for nondomestic use and in artistic pigments. Ceramic products available from noncommercial suppliers (such as local artists) often contain significant amounts of lead that can be leached from the ceramic by weak acids, such as vinegar and fruit juices. Lead is found in dirt from areas adjacent to homes painted with lead-based paints and highways where lead accumulates from use of leaded gasoline. Use of leaded gasoline has diminished significantly since the introduction of nonleaded gasolines that have been required in personal automobiles since 1972. Lead is found in soil near abandoned industrial sites where lead may have been used. Water transported through lead or lead-soldered pipe will contain some lead with higher concentrations found in water that is weakly acidic. Some foods/beverages (eg, moonshine distilled in lead pipes) and some traditional home medicines contain lead.
Lead expresses its toxicity by several mechanisms. It avidly inhibits aminolevulinic acid dehydratase and ferrochelatase, 2 of the enzymes that catalyze synthesis of heme; the end result is decreased hemoglobin synthesis resulting in anemia and increased levels of erythrocyte zinc protoporphyrin.
Lead is also an electrophile that avidly forms covalent bonds with the sulfhydryl group of cysteine in proteins. Thus, proteins in all tissues exposed to lead will have lead bound to them. The most common sites affected are epithelial cells of the gastrointestinal tract and epithelial cells of the proximal tubule of the kidney.
The typical diet in the United States contributes 1 to 3 mcg of lead per day, of which 1% to 10% is absorbed; children may absorb as much as 50% of the dietary intake, and the fraction of lead absorbed is enhanced by nutritional deficiency. The majority of the daily intake is excreted in the stool after direct passage through the gastrointestinal tract. While a significant fraction of the absorbed lead is rapidly incorporated into bone and erythrocytes, lead ultimately distributes among all tissues, with lipid-dense tissues such as the central nervous system being particularly sensitive to organic forms of lead. All absorbed lead is ultimately excreted in the bile or urine. Soft-tissue turnover of lead occurs within approximately 120 days.
Avoidance of exposure to lead is the treatment of choice. However, chelation therapy is available to treat severe disease. Oral dimercaprol may be used in the outpatient setting except in the most severe cases.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
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 (< or =15 years): > or =20.0 mcg/dL
Adults (> or =16 years): > or =70.0 mcg/dL
PROTOPORPHYRINS, FRACTIONATION
Free Protoporphyrin: <20 mcg/dL
Zinc-Complexed Protoporphyrin: <60 mcg/dL
Interpretation
Provides information to assist in interpretation of the test results
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 | > or =40 mcg/dL | Notification of worker in writing; medical examination of worker and consultation. |
| 3 (average) | > or =50 mcg/dL | Removal of worker from job with potential lead exposure. |
| 1 | > or =60 mcg/dL | Removal of worker from job with potential lead exposure. |
| 2 | <40 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.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
For protoporphyrin testing, patients must abstain from alcohol for at least 24 hours prior to specimen collection. Alcohol suppresses enzyme activity potentially leading to false-positive results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
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
Method Description
Describes how the test is performed and provides a method-specific reference
Lead
The metal of interest is analyzed by inductively coupled plasma mass spectrometry.(Unpublished Mayo method)
Protoporphyrins, Fractionation
Extraction followed by fractionation by high-performance liquid chromatography. Zinc protoporphyrin and free protoporphyrin are separately quantitated.(Smith RM, Doran D, Mazur M, Bush B. High-performance liquid chromatographic determination of protoporphyrin and zinc protoporphyrin in blood. J Chromatogr.1980;181[3-4]:319-327; Gou EE, Balwani M, Bissell DM, et al. Pitfalls in erythrocyte protoporphyrin measurement for diagnosis and monitoring of protoporphyrias. Clin Chem. 2015;61[12]:1453-1456. doi:10.1373/clinchem.2015.245456)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday, Wednesday, Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
83655
82542
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| PBPFD | Lead Profile Occ Exposure, B | 29588-1 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 8602 | Lead, B | 77307-7 |
| 2327 | Zinc-Complexed Protoporphyrin | 2895-1 |
| 2326 | Free Protoporphyrin | 94491-8 |
| 29511 | Interpretation | 59462-2 |
| VECP | Venous/Capillary | 31208-2 |
| PTADD | Patient Street Address | 56799-0 |
| PTCIT | Patient City | 68997-6 |
| 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 |