Letters to the Editor

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 305-306
Author(s):  
J. Julian Chisolm
Keyword(s):  
Whole Blood ◽  
Lead Concentration ◽  
Blood Lead ◽  
Metabolic Effect ◽  
Clear Distinction ◽  
Letters To The Editor ◽  
Opportunity To Respond ◽  
Heme Synthesis ◽  
Erythrocyte Protoporphyrin ◽  
Per Se

I am glad to have the opportunity to respond to Dr. Metcalf's letter to you concerning erythrocyte protoporphyrin tests. A clear distinction should be made between blood lead measurements and measurements such as erythrocyte protoporphyrin tests. Whole blood lead concentration primarily reflects current and recent absorption of lead, but is not a measure of toxicity, per se. Protoporphyrin is one of the heme metabolites which accumulates when heme synthesis is inhibited by lead and so provides a sensitive index of increasing adverse metabolic effect, as the concentration of lead in the tissues increases.

Letters to the Editor

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 304-304
Author(s):  
Thomas J. Metcalf
Keyword(s):  
Lead Exposure ◽  
Whole Blood ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Fine Motor ◽  
Motor Deficits ◽  
Letters To The Editor ◽  
Number Of Children ◽  
Screening Population ◽  
Undue Risk

Drs. Piomelli et al.1 propose the free erythrocyte protoporphyrin (FEP) test as a screen for "undue lead absorption." With the backing of Dr. Chisolm's Commentary,2 the FEP test may become the method of choice for screening population at risk for lead toxicity. I would like to suggest three points of caution: (1) By defining "undue risk" in terms of "ambiguous levels" of 40 to 59µg/100 ml of whole blood lead, the authors may miss the significant number of children shown by Drs. de la Burdé and Choate3 to have behavioral and fine motor deficits after asymptomatic lead exposure (> 30 to 40µg/100 ml with radiological evidence of ingestion).

Statement on Childhood Lead Poisoning

PEDIATRICS ◽  
1987 ◽  
Vol 79 (3) ◽  
pp. 457-465 ◽  
Author(s):  
◽  
Keyword(s):  
United States ◽  
Early Detection ◽  
Lead Poisoning ◽  
Lead Concentration ◽  
Blood Lead ◽  
The United States ◽  
Blood Lead Concentration ◽  
Childhood Lead Poisoning ◽  
Lead Absorption ◽  
Erythrocyte Protoporphyrin

Patterns of childhood lead poisoning have changed substantially in the United States. The mean blood lead level has declined, and acute intoxication with encephalopathy has become uncommon. Nonetheless, between 1976 and 1980, 780,000 children, 1 to 6 years of age, had blood lead concentrations of 30 µg/L or above. These levels of absorption, previously thought to be safe, are now known to cause loss of neurologic and intellectual function, even in asymptomatic children. Because this loss is largely irreversible and cannot fully be restored by medical treatment, pediatricians' efforts must be directed toward prevention. Prevention is achieved by reducing children's exposure to lead and by early detection of increased absorption. Childhood lead poisoning is now defined by the Academy as a whole blood lead concentration of 25 µg/L or more, together with an erythrocyte protoporphyrin level of 35 µg/dL or above. This definition does not require the presence of symptoms. It is identical with the new definition of the US Public Health Service. Lead poisoning in children previously was defined by a blood lead concentration of 30 µ/dL with an erythrocyte protoporphyrin level of 50 µg/dL. To prevent lead exposure in children, the Academy urges public agencies to develop safe and effective methods for the removal and proper disposal of all lead-based paint from public and private housing. Also, the Academy urges the rapid and complete removal of all lead from gasoline. To achieve early detection of lead poisoning, the Academy recommends that all children in the United States at risk of exposure to lead be screened for lead absorption at approximately 12 months of age by means of the erythrocyte protoporphyrin test, when that test is available. Furthermore, the Academy recommends follow-up erythrocyte protoporphyrin testing of children judged to be at high risk of lead absorption. Reporting of lead poisoning should be mandatory in all states.

Interlaboratory comparison of results of erythrocyte protoporphyrin analysis.

1978 ◽  
Vol 24 (12) ◽  
pp. 2135-2138 ◽  
Author(s):  
K W Jackson
Keyword(s):  
Acetic Acid ◽  
Hydrochloric Acid ◽  
Ethyl Acetate ◽  
Disease Control ◽  
Whole Blood ◽  
Interlaboratory Comparison ◽  
Direct Reading ◽  
Blood Samples ◽  
Erythrocyte Protoporphyrin ◽  
Whole Blood Samples

Abstract Each of 65 laboratories analyzed 10 whole-blood samples for erythrocyte protoporphyrin by one or more of several analytical procedures. These procedures were of two types: (a) extraction of protoporphyrin from the erythrocytes into ethyl acetate/acetic acid, re-extraction into hydrochloric acid, and fluorometric measurement; or (b) direct reading in a portable fluorometer (hematofluorometer), with no pretreatment of the blood sample. Interlaboratory correlation was generally poor, especially between laboratories using extraction procedures. Hematofluorometric results intercorrelated better, but they had a low bias as compared to the extraction approach. Nationwide standardization of the test is required to assure satisfactory interlaboratory performance and to identify laboratories whose results are sufficiently accurate to be used for interpretations according to guidelines set forth by the Center for Disease Control for erythrocyte protoporphyrin testing.

Screening for Lead Poisoning: Measurements and Methodology

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 303-304
Author(s):  
Gordon D. McLaren ◽  
William F. Barthel ◽  
Philip Landrigan
Keyword(s):  
Lead Poisoning ◽  
Lead Concentration ◽  
Blood Lead ◽  
Blood Lead Concentration ◽  
Extensive Experience

Piomelli et al.1 have presented an extensive experience in comparison of free erythrocyte porphyrin (FEP) levels with blood lead concentrations. Their finding that an FEP ≥ 250µg/100 ml RBC was invariably associated with a blood lead concentration ≥ 6Oµg/100 ml is consistent with data obtained in our laboratory2 using a somewhat different microfluorometric method for FEP determination.3 We must, however, take issue with the conclusion of Piomelli et al.1 that only FEP levels above 250µg/100 ml RBC should be considered "positive."

Longitudinal Study on Blood Lead Concentration and Childrenʼs Neurobehavioral Performance

Epidemiology ◽  
2011 ◽  
Vol 22 ◽  
pp. S278-S279 ◽  
Author(s):  
Joon Sakong ◽  
Ho-Jang Kwon ◽  
Mina Ha ◽  
Yun-Chul Hong ◽  
Chul-Gab Lee ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Lead Concentration ◽  
Blood Lead ◽  
Blood Lead Concentration ◽  
Neurobehavioral Performance
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