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Lead, Filter Paper Blood Spot (LEADBS)  

 
IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to NPHL@unmc.edu or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.

Please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459 for further clarification.

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Test: Lead, Filter Paper Blood Spot  
Synonym:  
Method: ICP-MS  
Availability:
  • Monday, Wednesday and Friday by 09:00 AM
  • Results in 24 hours after setup, unless samples need to be repeated (>10 µg/dL).
  • Friday results available the following Monday, unless a prepeat is necessary. 
 
Specimen: Whole blood   http://www.reglab.org/reglab/assets/File/UNMC%20Blood%20Spot%20Lead%20Collection%20ver2015(1).pdf  
Collection Device: Whatman 903 sample collection paper  
Volume:
  • 3 Complete Spots
****Circles on filter paper must be completely saturated through*****  
Storage/Transport:

Ambient

Samples can be Transported through the U.S. Mail using pre-addressed tyvek envelopes supplied by Regional Pathology Services. Patient demographic information required for lead testing: Patient full name, address, date of birth, type of specimen, race, reason for testing, provider name and addres, and patient insurance or Medicaide billling information, and diagnosis code if applicable.

 
Unacceptable: Blood Lead Collection Cautions:                                                                                                                                            
  • Failure to allow puncture site to air dry may cause the specimen to be diluted.                                                                                                                                                                                                                    
  • Milking or squeezing the puncture may cause hemolysis and add mixture of tissue fluids with specimen.                                                                                                                                                                                 
  • Do not layer successive drops of blood on the circle spot. If blood flow diminishes to incompletely fill circles repeat the capillary puncture and repeat collection using a new filter paper card.                                                                                                                                                                                                                            
  • Avoid touching area within circle before collection and blood spots after collection on filter paper. Do not allow water, feeding formulas, antiseptic solutions, etc. to come into contact with the sample.                                                                                                                                                                                                    
  • Do not place filter paper in the envelope until thoroughly dry.                                                                                                                                                                                                                                                              
  • Insufficient drying can adversely affect test results.                                                                                                                                                                                                                                                                                 
Other Reasons for Rejection                                                                                                                                                                                                           
  • Rough or wrinkled spot on paper, quantity of sample not sufficient for testing, Apparent dilution of blood spot, Multiple spotting.                                                                                                                                                                                                                             
  Based on NCCLS standard LA4-A2 Blood Collection on Filter paper for Neonatal Screening Programs-Second Edition  
Specimen Stability: 6 months at Ambient temperature  
Reference Interval:
Refence Interval:
<=3.5 µg/dL for children (<=15 years of age) and adults (>=16 years of age).
Notification rage >25.0µg/dL
Critical range: >45.0µg/dL
 
Reportable Disease: All results greater than 10 µg/dL from Nebraska are reported to the Nebraska Department of Health through the Douglas County Health Department  
Comments:
Interpretive Data:                      
Recommended Use:                    
Recommended for routine testing for lead exposure in pediatric populations. Confirm elevated results with a venous sample.  
CDC Blood lead reference value:3.5 µg/dL                  
For initial screening capillary BLL:                
<3.5  µg/dL: Not considered elevated.                  
3.5  µg/dL or higher: Obtain confirmatory venous sample . Anticipatory guidance about common sources of lead and how to prevent exposure.  
For Venous or Confirmatory BLL:                    
<3.5 µg/dL: Not considered elevated.                  
3.5-19 µg/dL: Follow-up blood lead monitoring, environmental exposure history, nutritional and educational counselling, and ensure iron sufficiency. Developmental assessment and monitoring.  Environmental investigation of the home if BLL>=10 µg/dL or as indicated by local health department  
 
20-44 µg/dL: Same as above. Complete history and physical exam, assess for signs and symptoms.        
45 µg/dL or higher: Same as above. Medical intervention, including physical and neurological exam. Consider chelation therapy. Contact state or local health department.  
 
                         
CDC Classification in Adults( >=16 years of age):                
<3.5 µg/dL: No action needed. Monitor BLL if ongoing exposure              
3.5-9 µg/dL: Discuss health risks. Minimize exposure. Reduce lead exposure for women who are or may become pregnant.    
10-19 µg/dL: Decrease exposure. Consider removal from lead exposure for certain medical conditions or BLL>10 for extended period. Increase monitoring and repeat BLL in 3 months  
20-29 µg/dL:   Remove from lead exposure. If repeat BLL measured in 4 weeks remains >=20  µg/dL. Remove from exposure for pregnancy  
30-49 µg/dL: Remove from lead exposure. Prompt medical evaluation            
50-79 µg/dL: Remove from lead exposure prompt medical evaluation. Consider Chelation therapy with significant symptoms or signs of lead toxicity.  
>80µg/dL: Remove from lead exposure. Urgent medical evaluation. Probable chelation therapy.        
                         
Source for children: "Recommended Actions Based on Blood Lead Level, CDC, 2021".          
Source for adults Recommendations of Medical Management of Adult Lead Exposure, Environmental Health Perspectives, 2007".  
 
Revised: 5/15/2023 
If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (800) 334-0459.

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