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Measurement Challenges at Low Blood Lead Levels.

Abstract In 2012, the Centers for Disease Control and Prevention (CDC) adopted its Advisory Committee on Childhood Lead Poisoning Prevention recommendation to use a population-based reference value to identify children and environments associated with lead hazards. The current reference value of 5 μg/dL is calculated as the 97.5th percentile of the distribution of blood lead levels (BLLs) in children 1 to 5 years old from 2007 to 2010 NHANES data. We calculated and updated selected percentiles, including the 97.5th percentile, by using NHANES 2011 to 2014 blood lead data and examined demographic characteristics of children whose blood lead was ≥90th percentile value. The 97.5th percentile BLL of 3.48 µg/dL highlighted analytical laboratory and clinical interpretation challenges of blood lead measurements ≤5 μg/dL. Review of 5 years of results for target blood lead values <11 µg/dL for US clinical laboratories participating in the CDC's voluntary Lead and Multi-Element Proficiency quality assurance program showed 40% unable to quantify and reported a nondetectable result at a target blood lead value of 1.48 µg/dL, compared with 5.5% at a target BLL of 4.60 µg/dL. We describe actions taken at the CDC's Environmental Health Laboratory in the National Center for Environmental Health, which measures blood lead for NHANES, to improve analytical accuracy and precision and to reduce external lead contamination during blood collection and analysis.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title pediatrics
Publication Year Start




PMID- 28771411
OWN - NLM
STAT- MEDLINE
DA  - 20170803
DCOM- 20170828
LR  - 20170828
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 140
IP  - 2
DP  - 2017 Aug
TI  - Measurement Challenges at Low Blood Lead Levels.
LID - e20170272 [pii]
LID - 10.1542/peds.2017-0272 [doi]
AB  - In 2012, the Centers for Disease Control and Prevention (CDC) adopted its
      Advisory Committee on Childhood Lead Poisoning Prevention recommendation to use a
      population-based reference value to identify children and environments associated
      with lead hazards. The current reference value of 5 mug/dL is calculated as the
      97.5th percentile of the distribution of blood lead levels (BLLs) in children 1
      to 5 years old from 2007 to 2010 NHANES data. We calculated and updated selected 
      percentiles, including the 97.5th percentile, by using NHANES 2011 to 2014 blood 
      lead data and examined demographic characteristics of children whose blood lead
      was &gt;/=90th percentile value. The 97.5th percentile BLL of 3.48 microg/dL
      highlighted analytical laboratory and clinical interpretation challenges of blood
      lead measurements &lt;/=5 mug/dL. Review of 5 years of results for target blood lead
      values &lt;11 microg/dL for US clinical laboratories participating in the CDC's
      voluntary Lead and Multi-Element Proficiency quality assurance program showed 40%
      unable to quantify and reported a nondetectable result at a target blood lead
      value of 1.48 microg/dL, compared with 5.5% at a target BLL of 4.60 microg/dL. We
      describe actions taken at the CDC's Environmental Health Laboratory in the
      National Center for Environmental Health, which measures blood lead for NHANES,
      to improve analytical accuracy and precision and to reduce external lead
      contamination during blood collection and analysis.
CI  - Copyright (c) 2017 by the American Academy of Pediatrics.
FAU - Caldwell, Kathleen L
AU  - Caldwell KL
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia [email protected]
FAU - Cheng, Po-Yung
AU  - Cheng PY
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Jarrett, Jeffery M
AU  - Jarrett JM
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Makhmudov, Amir
AU  - Makhmudov A
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Vance, Kathryn
AU  - Vance K
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Ward, Cynthia D
AU  - Ward CD
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Jones, Robert L
AU  - Jones RL
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
FAU - Mortensen, Mary E
AU  - Mortensen ME
AD  - Division of Laboratory Sciences, National Center for Environmental Health,
      Centers for Disease Control and Prevention, Atlanta, Georgia.
LA  - eng
PT  - Journal Article
DEP - 20170717
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
RN  - 2P299V784P (Lead)
SB  - AIM
SB  - IM
MH  - Child, Preschool
MH  - Female
MH  - Humans
MH  - Infant
MH  - Laboratory Proficiency Testing
MH  - Lead/*blood
MH  - Lead Poisoning/*blood/*prevention &amp; control
MH  - Male
MH  - Mass Screening
MH  - Nutrition Surveys
MH  - Quality Assurance, Health Care
MH  - Reference Values
MH  - United States
COI - POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential
      conflicts of interest to disclose.
EDAT- 2017/08/05 06:00
MHDA- 2017/08/29 06:00
CRDT- 2017/08/04 06:00
PHST- 2017/03/28 [accepted]
AID - peds.2017-0272 [pii]
AID - 10.1542/peds.2017-0272 [doi]
PST - ppublish
SO  - Pediatrics. 2017 Aug;140(2). pii: e20170272. doi: 10.1542/peds.2017-0272. Epub
      2017 Jul 17.