Predictive value of determinations of zinc protoporphyrin for increased blood lead concentrations

Author:

Froom Paul1,Kristal-Boneh Estella1,Benbassat Jochanan2,Ashkanazi Ruth3,Ribak Joseph1

Affiliation:

1. Occupational Health and Rehabilitation Institute, Raanana 43100, Israel, and the Department of Epidemiology, Sackler’s Medical School, University of Tel Aviv, Ramat Aviv 61396, Israel

2. Health Policy Research Program, JDC Brookdale Institute, Jerusalem 91130, Israel

3. Institute of Occupational Health, University of Tel Aviv, Ramat Aviv 61396, Israel

Abstract

Abstract Blood lead (PbB) and red cell zinc protoporphyrin (ZPP) concentrations are widely used biomarkers for lead toxicity. It is uncertain, however, whether either or both are needed for monitoring lead exposure and how discordant PbB and ZPP values should be interpreted. We reviewed the results of PbB and ZPP determinations in 94 workers in a lead-battery plant over a 13-year period and retrieved all 807 sets of tests in which both PbB and ZPP were available, with a follow-up PbB value 6 months later. PbB exceeded 1.93 μmol/L (40 μg/dL) in 414 (51%), and 2.90 μmol/L (60 μg/dL) in 105 (14%) of the blood samples. We derived the test properties of various ZPP concentrations for concurrent “toxic” PbB concentrations, defined as ≥1.93 and 2.90 μmol/L (40 and 60 μg/dL). The results indicated that, given a population of lead-exposed workers with a 10% prevalence of PbB of ≥2.90 μmol/L (60 μg/dL), a policy of testing PbB only in those with ZPP >0.71 μmol/L (40 μg/dL) would obviate 42% of the PbB tests, but would miss about three cases with toxic PbB concentrations in every 200 workers at risk. A finding of increased ZPP concentrations with a concurrent “nontoxic” PbB was associated with an increased risk of a toxic PbB concentration 6 months later. We conclude that (a) screening by testing only ZPP does not safeguard exposed persons against lead toxicity, and (b) the frequency of PbB monitoring should be guided by estimates of the risk of future lead toxicity in individual workers.

Publisher

Oxford University Press (OUP)

Subject

Biochemistry, medical,Clinical Biochemistry

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