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Clinical Chemistry 37: 216-225, 1991;
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Clinical Chemistry, Vol 37, 216-225, Copyright © 1991 by American Association for Clinical Chemistry

Observational study of erythrocyte protoporphyrin screening test for detecting low lead exposure in children: impact of lowering the blood lead action threshold

PJ Parsons, AA Reilly and A Hussain
Laboratory of Inorganic and Nuclear Chemistry, Wadsworth Center for Laboratories and Research, New York State Department of Health, Albany 12201-0509.

We examined a retrospective sample of 1800 children on whom both erythrocyte protoporphyrin (EP) and blood lead (BPb) measurements were taken. The primary objective was to ascertain whether EP is a cost- effective screening test for low but increased BPb concentrations and to establish the optimal thresholds. The data did not provide evidence of an EP threshold at low BPb concentrations; however, the data did show a significant age effect. A subset of 500 children for whom both EP and hematocrit data were available showed no correlation between those variables. Age-specific operating characteristic curves, total error, and cost analyses are presented. The latter sets bounds on the relative cost of EP testing, above which only BPb determination should be performed. The implications of these findings are discussed in light of impending changes in U.S. federal guidelines for preventing lead poisoning in young children.


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D. Esernio-Jenssen, V. Bush, and P. J. Parsons
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P. J. Parsons, A. A. Reilly, and D. Esernio-Jenssen
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Copyright © 1991 by the American Association for Clinical Chemistry.