Lead

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Also known as: Blood Lead Test; Blood Lead Level; BLL
Formal name: Lead, blood

At a Glance

Why Get Tested?

To screen for excessive exposure to lead

When to Get Tested?

As indicated by a child lead screening program or physician preference, such as at 1 and 2 years of age; children considered to be at risk may need additional testing from 18 months to 6 years of age; when your occupation or hobby may expose you or your family to lead; when you have symptoms suggesting lead poisoning

Sample Required?

A blood sample taken from a vein in your arm or by fingerstick or heelstick (for infants)

Test Preparation Needed?

None

The Test Sample

What is being tested?

This test measures the current lead level in the blood. Lead is a soft metal present in the environment. When it is inhaled or ingested, lead can cause damage to the brain, organs, and nervous system. Even at low levels, it can cause irreversible damage without causing physical symptoms. In an infant, lead can cause permanent cognitive impairment, behavioral disorders, and developmental delays. Lead exposure can cause weakness, anemia, nausea, weight loss, fatigue, headaches, stomach pain, and kidney, nervous system, and reproductive dysfunction. Lead can be passed from mothers to their unborn children and can cause miscarriages and premature births.

In the past, lead was used in paints, gasoline, water pipes, and other household products, such as the solder used in canned food. Although these uses have been limited in the U.S., lead is still used in many products and industrial processes both in the U.S. and around the world. Housing built prior to 1978 is likely to contain lead-based paint and lead-contaminated household dust, especially if the house was built prior to 1950. Soil surrounding these houses may also be contaminated with lead.

Children under 6 years of age are the most likely to be exposed to lead because of their increased hand-to-mouth behavior and high absorption rates. The lead gets into their bodies by their ingesting lead dust or paint chips, inhaling dust, mouthing or chewing items that contain lead or have been contaminated by lead, and/or by eating contaminated food or water. Adult lead exposure is usually related to occupational or recreational (hobby) exposure. Children of those who work with lead may also become exposed when lead contamination is brought home on the work clothes of their parents.

How is the sample collected for testing?

Blood is drawn from a vein in the arm. Sometimes, blood is collected by fingerstick (or heelstick for infants). If test results from a fingerstick are abnormal, a venous blood draw should be ordered to confirm the results.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

APHA. CDC Accepts Advisory Committee Recommendation to Replace "Level of Concern" for Lead Poisoning with New Reference Value. Washington, D.C. May 16, 2012. Available online at http://www.apha.org/about/news/pressreleases/2012/cdc+advisory+new+reference+value.htm through http://www.apha.org. Accessed May 2012.

Centers for Disease Control and Prevention. CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in "Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention." PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/CDC_Response_Lead_Exposure_Recs.pdf through http://www.cdc.gov. Accessed May 2012.

KidsHealth.org. Blood Test: Lead. Available online at http://kidshealth.org/parent/system/medical/test_lead.html# through http://kidshealth.org. Accessed February 2012. 

(January 4, 2012) Report of the Advisory Committee on Childhood Lead Poisoning Prevention of the Centers for Disease Control and Prevention, Low Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention. PDF available for download at http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_011212.pdf through http://www.cdc.gov. Accessed February 2012. 

HealthyChildren.org. Lead Poisoning. Available online through http://www.healthychildren.org. Accessed February 2012.

American Academy of Pediatrics. Lead Exposure in Children: Prevention, Detection, and Management. Pediatrics Vol. 116 No. 4 October 1, 2005, Pp 1036 -1046. Available online at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1036#SEC7 through http://aappolicy.aappublications.org. Accessed February 2012.

Donald L. Simmons, Ph.D. Laboratory Manager. State Hygienic Laboratory - Ankeny Ankeny, IA.

OSHA Blood Lead Regulations. Available online at http://www.ehow.com/about_5538910_osha-blood-lead-regulations.html through http://www.ehow.com. Accessed April 2012. 

Wengrovitz, Anne M. and Brown, Mary Jean. Recommendations for Blood Lead Screening of Medicaid-Eligible Children Aged 1--5 Years: an Updated Approach to Targeting a Group at High Risk. MMWR. August 7, 2009. 58(RR09);1-11. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm through http://www.cdc.gov. Accessed June 2012.

Sources Used in Previous Reviews

National Center for Environmental Health. Screening Young Children for Lead Poisoning, 1997. Available online at http://www.cdc.gov/nceh/lead/guide/guide97.htm through http://www.cdc.gov.

California Department of Health Services, Occupational Health Branch. "How to Prevent Lead Poisoning on Your Job", 2000. Pp 9,10,23.

Hipkins KL, Materna BL, Kosnett MJ, Rogge JW, Cone JE. Medical surveillance of the lead exposed worker. AAOHN Journal 46(7):330-339.

Todd AC, et al. "Unraveling the chronic toxicity of lead: An essential priority for environmental health". Environmental Health Perspectives, 104(Supp 1):141-146; March 1996.

A Manual of Laboratory & Diagnostic Tests (sixth edition), Frances Fischbach, editor. Philadelphia: Lippincott Williams& Wilkins, 2000; Pp 398-400; 1179-1180.

General Industry Federal OSHA Lead Standard, 29 CFR 1910.1025

Residential Lead Hazard Standards - TSCA Section 403 Environmental Protection Agency, Office of Pollution Prevention and Toxics. Available online at http://www.epa.gov/lead/leadhaz.htm through http://www.epa.gov.

Blood Lead Levels in Young Children — United States and Selected States, 1996-1999 Centers for Disease Control and Prevention, MMWR December 22, 2000 / 49(50);1133-7.

Management Guidelines for Blood Lead Levels in Children and Adults. California Department of Health Services. Available online at http://www.dhs.cahwnet.gov/ohb/OLPPP/mgmtgdln.htm through http://www.dhs.cahwnet.gov.

Michael E. Ottlinger, PhD. Senior Toxicologist, Centers for Disease Control and Prevention, Cincinnati, OH.

Mitchell G. Scott, PhD. Division of Laboratory Medicine, Washington University School of Medicine, St. Louis, MO.

Raymond K. Meister, MD, MPH. Occupational health physician.

Thomas P. Moyer, PhD. Professor of Laboratory Medicine, Division of Clinical Biochemistry & Immunology, Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN.

(2005 October 1). Lead Exposure in Children: Prevention, Detection, and Management. American Academy of Pediatrics, PEDIATRICS Vol. 116 No. 4 October 2005, Pp. 1036-1046.

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(2005 June 23, Reviewed) Lead Health Effects. U.S. Department of Labor, Occupational Safety & Health Administration [On-line information]. Available online at http://www.osha.gov/SLTC/lead/recognition.html through http://www.osha.gov.

(2005 July, Updated). Lead Poisoning in Children. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/617.xml through http://familydoctor.org.

(2005 September, Revised). Management Guidelines for Blood Lead Levels in Children and Adults. California Department of Health Services [On-line information]. PDF available for download at http://www.dhs.ca.gov/ohb/OLPPP/mgmtgdln.pdf through http://www.dhs.ca.gov.

Hipkins, K. et. al. (2004 November/December). Family Lead Poisoning Associated with Occupational Exposure. Clin Pediatr 2004;43:845-849. PDF available for download at http://www.dhs.ca.gov/ohb/OLPPP/family_lead_poisoning.pdf through http://www.dhs.ca.gov.

(2005 May 25, Reviewed). CDC Childhood Lead Poisoning Prevention Program, CDC Recommendations for Lead Poisoning Prevention in Newly Arrived Refugee Children. CDC National Center for Environmental Health [On-line information]. Available online at http://www.cdc.gov/nceh/lead/Refugee%20recs.htm through http://www.cdc.gov.

(2005 September). ToxFAQs™ for Lead. Agency for Toxic Substances and Disease Registry (ATSDR) [On-line information]. Available online at http://www.atsdr.cdc.gov/tfacts13.html through http://www.atsdr.cdc.gov.

(2005 September). Public Health Statement, from Toxicological Profile for Lead, Draft for Public Comment. Agency for Toxic Substances and Disease Registry (ATSDR) [[On-line information]. Available online at http://www.atsdr.cdc.gov/toxprofiles/tp13.html through http://www.atsdr.cdc.gov.

(2006 January 13, Reviewed). General Lead Information, Questions and Answers. CDC, National Center for Environmental Health [On-line information]. Available online at http://www.cdc.gov/nceh/lead/faq/about.htm through http://www.cdc.gov.

(2002 March). Managing Elevated Blood Lead Levels Among Young Children: Recommendations from the Advisory Committee on Childhood Lead Poisoning Prevention. CDC [On-line information]. Available online at http://www.cdc.gov/nceh/lead/CaseManagement/caseManage_main.htm through http://www.cdc.gov.

(2003 September 12). Surveillance for Elevated Blood Lead Levels Among Children --- United States, 1997—2001 CDC MMWR [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5210a1.htm through http://www.cdc.gov.

(2004 July 9). Adult Blood Lead Epidemiology and Surveillance --- United States, 2002. CDC MMWR [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a2.htm through http://www.cdc.gov.

SN Tsekrekos, I Buka. Paediatr Child Health Vol 10, No 4. April 2005.

Dr. Irena Buka MB, ChB, FRCPC. Pediatric Environmental Health Clinic. Edmonton, Alta. Canada.

Harold E. Hoffman, MD, FRCPC, FACOEM. Occupational & Environmental Medicine. Edmonton, Alberta, Canada.

Kathy Leinenkugel, CLS. Lead Program Coordinator, Douglas County Health Department. Omaha, NE.

Thomas P. Moyer, Ph.D. Professor of Laboratory Medicine, Mayo College of Medicine. Vice Chair for Diagnostic Development, Department of Laboratory Medicine & Pathology. Co-Director for Medical Affairs, Mayo Collaborative Services, Inc. Mayo Clinic, Rochester, MN.

Clarke, W. and Dufour, D. R., Editors (© 2006). Contemporary Practice in Clinical Chemistry: AACC Press, Washington, DC. Pp 474.

Wu, A. (© 2006). Tietz Clinical Guide to Laboratory Tests, 4th Edition: Saunders Elsevier, St. Louis, MO. Pp 658-659.

(Updated 2008 May 30). Lead. U.S. Dept of Labor OSHA [On-line information]. Available online at http://www.osha.gov/SLTC/lead/index.html through http://www.osha.gov. Accessed June 2009.

(Updated 2009 February 01). Lead. ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/substances/toxsubstance.asp?toxid=22 through http://www.atsdr.cdc.gov. Accessed June 2009.

(Updated 2007 October 05) ToxFAQs™ for Lead. ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/tfacts13.html through http://www.atsdr.cdc.gov. Accessed June 2009.

(2009 May 19). Lead in Paint, Dust, and Soil. U.S. Environmental Protection Agency [On-line information]. Available online at http://www.epa.gov/opptintr/lead/index.html through http://www.epa.gov. Accessed June 2009.

Alexander, D. (Updated 2007 May 25). Lead levels – blood [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003360.htm. Accessed June 2009.

(2007 November 2). Interpreting and Managing Blood Lead Levels <10 µg/dL in Children and Reducing Childhood Exposures to Lead. CDC MMWR 56(RR08);1-14;16 [On-line information]. Available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5608a1.htm through http://www.cdc.gov. Accessed June 2009.

(Revised 2007 August 20). Case Studies in Environmental Medicine (CSEM), Lead Toxicity, What Tests Can Assist with Diagnosis of Lead Toxicity? ATSDR [On-line information]. Available online at http://www.atsdr.cdc.gov/csem/lead/pbtests_diagnosis2.html through http://www.atsdr.cdc.gov. Accessed June 2009.

(Updated 2008 September) Lead Poisoning. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ToxinsTraceMetals/LeadPoisoning.html through http://www.arupconsult.com. Accessed June 2009.