Lead, Capillary


Sunquest Code:PBCAP  
Epic Code:LAB7030Epic Name:Lead, Capillary
Synonyms:PB; Capillary; PBCL
Methodology:Electrochemistry
CPT Code:----------CPTCODES HERE----------
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 test 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, Blood Venous (LAB6973)
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:
 

Only capillary samples may be used. For venous collections, see Lead, Blood Venous (LAB6973). Lead is present everywhere in our environment. Trace amounts of lead on skin, blood collection materials, or even paper towels may cause falsely increased blood levels. To minimize the risk of sample contamination.

  1. Keep collection area clean and free of dust.
  2. Prior to collection, have the patient wash hands thoroughly with soup and water and instruct them to shake their hands dry. Paper towels are a potential source of lead contamination. After washing, patient should not touch anything with their fingers.
  3. Hold the finger and massage the collection site with a fresh, clean glove to increase blood flow.
  4. Clean the collection area with an alcohol prep and allow to air dry.
  5. After puncture of skin, allow first drop of blood to fall freely onto a gauze. Do not wipe or blot the drop away.
  6. If collecting into multiple containers, collect the lead sample first.
  7. Do not allow blood to flow over finger nails.
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°-25°C) Samples must be treated in the Special Chemistry laboratory within 72 hours of collection.
Shipping Instructions:Ship whole blood at room temperature or refrigerated temperature (1°-25°C). Send samples as soon as possible following collection. Samples must be treated in the Special Chemistry laboratory within 72 hours of collection.
Stability:72 hours at room temperature or refrigerated temperature.
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.   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:Capillary samples are more susceptible to contamination then venous collections. Elevated capillary results must be confirmed using a venous specimen collected in a certified lead-free collection tube. See Lead, Blood Venous (LAB6973).
Do not collect specimens for lead testing from patients who have received gadolinium-, iodine-, or barium-containing contrast material within the past 96 hours.
Use:Evaluate lead toxicity in pediatric patients or in adults with phlebotomy considerations.


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