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Zinc Protoporphyrin

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Also known as: ZPP; ZP; Free Erythrocyte Protoporphyrin; FEP; ZPP/Heme Ratio
Formal name: Zinc Protoporphyrin

At a Glance

Why Get Tested?

To screen for and monitor chronic exposure to lead; to detect iron deficiency in children

When to Get Tested?

When you have been chronically exposed to lead, as part of a program to monitor lead exposure, and/or when your doctor suspects lead poisoning; as part of a screening program for iron deficiency in children and adolescents

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

None

The Test Sample

What is being tested?

This test measures the level of zinc protoporphyrin (ZPP) in the blood. ZPP is normally present in red blood cells in small amounts, but its value may increase in people with lead poisoning and iron deficiency. To understand how this happens, it is first necessary to know about heme.

Heme is an essential component of hemoglobin, the protein in red blood cells that carries oxygen from the lungs to the body's tissues and cells. The formation of heme occurs in a series of steps that conclude with the insertion of an iron atom into the center of a molecule called protoporphyrin. If there is not enough iron available, as in iron deficiency, or if the insertion of iron is inhibited, as in lead poisoning, then protoporphyrin combines with zinc instead of iron to form zinc protoporphyrin. ZPP serves no useful purpose in red blood cells since it cannot bind to oxygen.

ZPP may be measured in one of two ways:

  • The free erythrocyte protoporphyrin (FEP) test measures both ZPP, which accounts for 90% of protoporphyrin in red blood cells, and free protoporphyrin, which is not bound to zinc.
  • The ZPP/heme ratio gives the proportion of ZPP compared to the normal iron-containing heme in red blood cells.

How is the sample collected for testing?

To measure FEP, a blood sample is taken by inserting a needle into a vein in the arm. To determine the ZPP/heme ratio, a drop of blood from a fingerstick is placed in an instrument called a hematofluorometer. This instrument measures the fluorescence of ZPP and reports the amount of ZPP per number of heme molecules. Since only a single drop of blood is required, this test is well suited for screening children.

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

(March 12, 2011) Mayo Clinic. Symptoms of Lead Poisoning. Available online at http://www.mayoclinic.com/health/lead-poisoning/FL00068/DSECTION=symptoms through http://www.mayoclinic.com. Accessed April 2011.

(August 6, 2010) Barclay B. Iron-Deficiency Anemia Linked to Memory Deficits in Children. Medscape Medical News. Available online at http://www.medscape.com/viewarticle/726423 through http://www.medscape.com. Accessed April 2011.

Mayo Medical Laboratories. Zinc Protoporphyrin, Blood.  Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/300009 through http://www.mayomedicallaboratories.com. Accessed April 2011.

(July 26, 2010) Agency for Toxic Substances and Disease Registry. Case Studies in Environmental Medicine, Lead Toxicity: What Tests Can Assist with Diagnosis of Lead Toxicity? Available online at http://www.atsdr.cdc.gov/csem/lead/pbtests_diagnosis2.html through http://www.atsdr.cdc.gov. Accessed April 2011.

OSHA: Regulations (Standards - 29 CFR). Medical Surveillance Guidelines - 1926.62 App C, June 24 1993. Available online at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10644 through http://www.osha.gov. Accessed April 2011.

Baumann-Blackmore NL, et.al. Cord blood zinc protoporphyrin/heme ratio in minority neonates at risk for iron deficiency. J Pediatr. 2008 Jul;153(1):133-6. Available online at http://www.ncbi.nlm.nih.gov/pubmed/18571551 through http://www.ncbi.nlm.nih.gov. Accessed April 2011.

Zimmerman M, et al. Serum transferrin receptor and zinc protoporphyrin as indicators of iron status in African children. American Journal of Clinical Nutrition, Vol. 81, No. 3, 615-623, March 2005. Available online at http://www.ajcn.org/content/81/3/615.full through http://www.ajcn.org. Accessed April 2011.

Rettmer R, et al. Zinc Protoporphyrin/Heme Ratio for Diagnosis of Preanemic Iron Deficiency. Pediatrics, Sep 1999; 104: e37. Available online at http://pediatrics.aappublications.org/cgi/content/full/104/3/e37 through http://pediatrics.aappublications.org. Accessed April 2011.

(April 2011) National Heart, Lung, Blood Institute. How is iron-deficiency anemia diagnosed? Available online at http://www.nhlbi.nih.gov/health/dci/Diseases/ida/ida_diagnosis.html through http://www.nhlbi.nih.gov. Accessed April 2011.

ARUP Laboratories. Test Directory Catalog, Zinc Protoporphyrin (ZPP), Whole Blood Industrial. Available online at http://www.aruplab.com/guides/ug/tests/0020614.jsp through http://www.aruplab.com. Accessed May 2011.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

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

Porphyrins, Blood and Serum. ARUPs Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_143b.jsp#1145040 through http://www.arup-lab.com.

(2000 May 19, Revised). The Interaction of Iron and Erythropoietin. Information Center for Sickle Cell and Thalassemic Disorders [On-line information]. Available online at http://sickle.bwh.harvard.edu/iron_epo.html through http://sickle.bwh.harvard.edu.

Iron Metabolism Disorders. ZPP Hematofluorometer. AVIV Biomedical [On-line information]. Available online at http://www.avivbiomedical.com/Pages/IRON%20METAB.html through http://www.avivbiomedical.com.

Staudinger, K. and Roth, V. (1998 February 15). Occupational Lead Poisoning. American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/980215ap/stauding.html through http://www.aafp.org.

Labbe, R., et. al. (1987). Zinc protoporphyrin. Past, present, and future. Annals of the New York Academy of Sciences, vol 514 (1) [Abstract]. Available online at http://www.annalsnyas.org/cgi/content/abstract/514/1/7 through http://www.annalsnyas.org.

Mei, Z., et. al. (2003). Erythrocyte protoporphyrin or hemoglobin: which is a better screening test for iron deficiency in children and women? American Society for Clinical Nutrition, AM J Clin Nutr 2003;77:1229-33.

Roh, Y., et. al. (2000). Zinc Protoporphyrin IX Concentrations between Normal Adults and the Lead-Exposed Workers Measured by HPLC, Spectrofluorometer, and Hematofluorometer. Industrial Health 2000, 38, 372-379. [On-line journal]. PDF available for download at http://www.niih.go.jp/en/indu_hel/2000/pdf/IH38_48.pdf through http://www.niih.go.jp.

The Heme Biosynthetic Pathway. The Merck Manual of Diagnosis and Therapy. [On-line information]. Available online at http://www.merck.com/mrkshared/mmanual/section2/chapter14/14a.jsp through http://www.merck.com.

Lead Poisoning. The Merck Manual of Diagnosis and Therapy [On-line information]. Available online at http://www.merck.com/mrkshared/mmanual/section19/chapter263/263b.jsp through http://www.merck.com.

DiGuiseppi, C. (1996). Guide to Clinical Preventive Services, Second Edition Metabolic, Nutritional, and Environmental Disorders Screening for Elevated Lead Levels in Childhood and Pregnancy, Recommendation. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd Edition. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 1996. [On-line information]. Available online at http://cpmcnet.columbia.edu/texts/gcps/gcps0033.html through http://cpmcnet.columbia.edu.

(60 FR 52856, Oct. 11, 1995; 63 FR 1152, Jan. 8, 1998) Regulations (Standards - 29 CFR), Employee standard summary - 1910.1025 App B. U.S. Department of Labor, Occupational Safety & Health Administration (OSHA) [Current on-line Regulation Standard for Lead Exposure]. Available online through http://www.osha.gov.

(57 FR 26627, May 4, 1993, as amended at 58 FR 34218, June 24, 1993). Regulations (Standards - 29 CFR), Medical Surveillance Guidelines - 1926.62 App C. U.S. Department of Labor, Occupational Safety & Health Administration (OSHA) [Current on-line Regulation Standard for Lead Exposure]. Available online through http://www.osha.gov.

 Labbe, R., et. al. (1999). Observations on the Zinc Protoporphyrin/Heme Ratio in Whole Blood. Clinical Chemistry, Technical Briefs 45:146-148 [On-line journal]. Available online at http://www.clinchem.org/cgi/content/full/45/1/146 through http://www.clinchem.org.

Labbe, R., et. al. (1999). Zinc Protoporphyrin: A Metabolite with a Mission. Clinical Chemistry 45:2060-2072 [On-line journal]. Available online at http://www.clinchem.org/cgi/content/full/45/12/2060 through http://www.clinchem.org.

CDC. Preventing Lead Poisoning in Young Children. Available online at http://www.cdc.gov/nceh/lead/publications/books/plpyc/chapter3.htm#Lead-Based%20Paint through http://www.cdc.gov.

Wu, A. (2006). Tietz Clinical Guide to Laboratory Tests, Fourth Edition. Saunders Elsevier, St. Louis, Missouri. Pp 1154-1156.

(1993 June 24, Amended). Regulations (Standards - 29 CFR) Medical Surveillance Guidelines - 1926.62 App C. OSHA (Occupational Safety & Health Administration Medical Surveillance Guidelines [On-line information].  Available online at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10644 through http://www.osha.gov. Accessed on 8/16/07.

(2006 July). Comparative Effectiveness of Zinc Protoporphyrin and Hemoglobin Concentrations in Identifying Iron Deficiency in a Group of Low-Income, Preschool-Aged Children: Practical Implications of Recent Illness. Pediatrics v118(1) [On-line information]. Available online at http://pediatrics.aappublications.org/cgi/content/abstract/118/1/224 through http://pediatrics.aappublications.org. Accessed on 8/18/07.

Rettmer, R. et. al., (1999 September 3). Zinc Protoporphyrin/Heme Ratio for Diagnosis of Preanemic Iron Deficiency. Pediatrics v104 (3) [On-line information]. Available online at http://pediatrics.aappublications.org/cgi/content/full/104/3/e37 through http://pediatrics.aappublications.org. Accessed on 8/16/07.

(© 2007). Zinc Protoporphyrin (ZPP), Whole Blood. ARUP's Laboratory Test Directory [On-line information]. Available online at http://www.aruplab.com/guides/ug/tests/0020605.jsp through http://www.aruplab.com. Accessed on 8/18/07.

(© 2007). Protoporphyrin, Free Erythrocyte, and Zinc Protoporphyrin. LabCorp Test Information [On-line information].  Available online at http://www.labcorp.com/datasets/labcorp/html/chapter/mono/bm007100.htm through http://www.labcorp.com. Accessed on 8/18/07.

Dombeck TA and Satonik RC. The Porphyrias. Emergency Medicine Clinics of North America. Volume 23, Issue 3, Pp 885-899.

Arup Laboratories. Test Directory: Zinc Protoporphyrin (Online information). Available online at http://www.aruplab.com/guides/ug/tests/0020605.jsp through http://www.aruplab.com. Accessed October 2007.

Quest Diagnostics. Test Menus: Zinc Protoporphyrin (Online information). Available online through http://cas2.questdiagnostics.com. Accessed October 2007.

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