Lead, Capillary


Sunquest Code:PBCAP  
Epic Code:LAB7030Epic Name:Lead, Capillary
Synonyms:PB; Capillary; PBCL
Methodology:Electrochemistry
CPT Code:83655
Turnaround Time:Performed 7 days/week; results are reported within 24 hours.
Special Instructions:Medical laboratories performing blood lead analyses must report the results of all blood lead tests; whether from fingerstick or venous samples, to the Minnesota Department of Health. A completed blood lead report form must be sent with each Outreach sample. See Associated Links.

  Capillary specimens only. Venipuncture samples have different specimen requirements. See Lead, Venous Blood Confirmation for additional information.
Associated Links:

MDH Blood Lead Report Form



Collection Instructions

Specimen:Blood
Optimal Volume:0.5 mL - EDTA tubes must contain >50% of intended tube volume
Minimum\Peds Volume:0.25 mL - EDTA tubes must contain >50% of intended tube volume
Container:Purple microtainer, only for pediatric fingerstick (Green (lithium heparin, no gel) pediatric patients only)
Collection Instructions:

Capillary specimens only

Capillary specimens must be collected carefully to minimize possible contamination from lead on the skin surface. Capillary specimens are usually collected from the heel of a child less than one year old or from the finger of an older child.

1.   Put exam gloves on and rinse under flowing tap water to remove any powder.

2.   Wash the child’s hand (or foot) thoroughly with soap and water, preferably using a brush; rinse and dry with a paper towel. Do not allow the child’s fingers (or foot) to touch clothing or skin surfaces that have not been cleaned.

3.   Grasp the finger or foot that has been selected for the puncture, with the palm up. Massage the finger or foot gently to increase the blood flow.

4.   Clean the puncture site with an alcohol swab, dry the area with a sterile gauze.

5.   Do not allow blood to run down finger or foot or onto the nails as this can cause significant contamination of the specimen.

 

Causes for Rejection:Clotted specimens, gel separators, or EDTA tubes that contain less than half of the intended fill volume. Venous sample collected in a capillary tube.


Processing and Shipping

Specimen Processing:Do not centrifuge, whole blood. Store at room or refrigerated temperature (1 C - 25 C). Samples must be treated in the Special Chemistry laboratory within 72 hours of collected.
Shipping Instructions:Ship whole blood at room temperature or refrigerated temperature (1 C - 25 C). Send samples as soon as possible following collection. Samples must be treated in the Special Chemistry laboratory within 72 hours of collection.
Test Performed at or Referral Lab Specialty Core  (UMMC-East Bank)


Interpretive

Reference Range:

 

Less than 5.0 ug/dL– Normal (unexposed population)

This reference value is based on the 97.5th percentile of the National Health and Nutrition Examination Survey (NHANES)’s blood lead distribution in children. The current reference value is based on NHANES data from 2007-2008 and 2009-2010. CDC will update the reference value every 4 years using the two most recent NHANES surveys.

 

Results of 5.0 ug/dL or greater will be sent for confirmation and will generate an additional charge.

Elevated levels of blood lead should be confirmed with a second venipuncture specimen before remedial action is instituted. Refer to CDC recommendations for appropriate remedial action for children. Refer to OSHA guidelines for appropriate remedial action for occupationally exposed adults

 

Blood Lead in Children

According to CDC Classification (1991)

Class

Blood Level*

ug/dL

Comment

I

Less than 5

Not lead-poisoned.

IIA

5-14

For blood levels of 5-14 ug/dL, provide the appropriate follow-up interventions listed below:

a. If capillary result: Confirm with a venous draw within 3 months

b. If venous result: Check the nutritional status (especially iron and calcium) to rule out iron deficiency and treat if present.

c. If capillary or venous result: Provide anticipatory guidance regarding high risk categories and primary sources of lead poisoning.

IIB

15-19

Institute nutritional and educational interventions.

III

20-44

Evaluate environment and consider chelation therapy.

IV

45-69

Institute environmental intervention and chelation therapy.

V

70 or greater

Medical emergency.

*Elevated levels of blood lead should be confirmed with a second specimen before remedial action is instituted.

 

Blood Lead in Adults

Blood Level*

ug/dL

Comment

Less than 5.0

No action required.

5.0-24.9

Identify and minimize exposure.

25.0-49.9

Remove from exposure if symptomatic.

50.0-79.9

Remove from lead exposure, immediate medical evaluation.

80.0 or greater

Chelation may be indicated if symptomatic.  Seek consultation.

*Blood lead in adults, occupationally exposed: Refer to OSHA guidelines.

 

 

 

Limitations:The University of Minnesota Medical Center performs whole blood lead testing by the Magellan LeadCare Ultra instrument. According to a CDC Health alert, venous blood samples might result in falsely low test results by this assay. This does not apply to capillary blood collected by fingerstick or heelstick.
Use:Evaluate lead toxicity.


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