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Updated Clinical Chemistry and Toxicology Document on Measurement Procedures for the Determination of Lead Concentrations in Blood and Urine

The Clinical and Laboratory Standards Institute (CLSI) has published a new version of C40-A2—Measurement Procedures for the Determination of Lead Concentrations in Blood and Urine; Approved Guideline—Second Edition. C40-A2 is intended for members of the clinical laboratory testing community involved in the collection and measurement of lead in blood and urine.

C40-A2 provides direction for specimen collection, measurement by graphite furnace atomic absorption spectrometry, anodic stripping voltammetry, and inductively coupled plasma mass spectrometry. It includes guidelines for quality assurance and quality control, as well as information on proficiency testing programs and laboratory certification. This edition of the document addresses the clinical significance of lead concentrations < 10 μg/dL (0.48 μmol/L). It discusses the definition of elevated blood lead concentrations in children based on a reference value of 5 μg/dL (0.24 μmol/L), covers the use of filter paper in blood collection for lead screening, and provides general information on sample preparation and analysis by inductively coupled plasma mass spectrometry.

“In light of increasing knowledge of detrimental effects of blood lead level below 10 μg/dL, and the new Centers for Disease Control and Prevention reference value of elevated blood lead in children of 5 μg/dL, there is an increasing need for sensitive, precise, and accurate methods for measuring lead. This document provides the concepts, guidelines, and procedures for measurement of blood and urine lead levels,” states Uttam Garg, PhD, DABCC, DABFT, FACB, C40-A2 committee chairholder, Professor at UMKC and KU School of Medicine, Technical Director at the Division of Laboratory Medicine, and Director at the Clinical Chemistry and Toxicology Laboratory’s Department of Pathology and Laboratory Medicine for Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.

CLSI is a not-for-profit membership organization that brings together the varied perspectives and expertise of the worldwide laboratory community for the advancement of a common cause: to foster excellence in laboratory medicine by developing and implementing clinical laboratory standards and guidelines that help laboratories fulfill their responsibilities with efficiency, effectiveness, and global applicability.

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