From the Guidelines
For a 2-year-old with hyperleademia (elevated serum lead level), a confirmatory venous blood lead level test should be ordered immediately. This is essential because capillary samples can sometimes be contaminated, leading to false elevations 1. Additional testing should include a complete blood count with peripheral smear to assess for anemia and basophilic stippling, iron studies (including ferritin, as iron deficiency can increase lead absorption), and a comprehensive metabolic panel to evaluate organ function.
Key Considerations
- Abdominal X-rays may be indicated if ingestion of lead-containing objects is suspected.
- For children with significantly elevated levels (≥45 μg/dL), an electrocardiogram and neurological assessment should be considered.
- These tests help determine the severity of lead exposure, identify potential sources, guide chelation therapy decisions, and establish baseline measurements for monitoring treatment effectiveness.
Importance of Early Detection
Early detection and intervention are critical as lead exposure can cause irreversible neurodevelopmental damage, particularly in young children whose developing brains are especially vulnerable 1. The American Academy of Pediatrics recommends that children with elevated blood lead concentrations be monitored until environmental investigations and remediation are complete and blood lead concentrations decline 1.
Recommended Tests
Some key tests to consider include:
- Confirmatory venous blood lead level test
- Complete blood count with peripheral smear
- Iron studies (including ferritin)
- Comprehensive metabolic panel
- Abdominal X-rays (if ingestion of lead-containing objects is suspected)
- Electrocardiogram and neurological assessment (for children with significantly elevated levels)
From the Research
Diagnostic Testing for Elevated Serum Lead Levels
After determining that a 2-year-old has an elevated serum lead level, the following tests should be considered:
- A venous blood lead test to confirm the diagnosis and determine the level of lead exposure 2, 3
- An 8-hour CaNa2EDTA provocative test to assess lead stores in the child's body 4
- EDTA provocation testing to evaluate the child's lead burden and guide chelation therapy 5
Considerations for Diagnostic Testing
When interpreting the results of diagnostic tests, consider the following:
- The sensitivity and specificity of capillary blood lead screening tests in predicting elevated venous blood lead levels 2
- The risk of false-positive results and the potential for unnecessary follow-up testing 3
- The use of EDTA provocation testing and chelation therapy in children with elevated blood lead levels 5, 4
Additional Evaluations
Additional evaluations may be necessary to identify the source of lead exposure and to guide treatment, including: