title: Comparison of capillary earlobe and venous blood monitoring for occupational lead surveillance.
abstract: Biological monitoring for occupational lead exposure involves routine venous blood draws from exposed employees. This uncomfortable procedure normally yields more blood than what is needed for analysis. Capillary blood sampling is less invasive but introduces the possibility of surface contamination. The objective of this study was to compare venous and capillary (earlobe) blood lead samples obtained from occupationally exposed individuals. Phlebotomists trained specifically in the collection of blood samples for lead determination collected 2 venous blood samples and 2 capillary earlobe samples from each participating employee. Before the capillary draw, the employee's earlobe was cleansed with an alcohol wipe in an effort to remove potential lead contamination. A second alcohol wipe was then used to sanitize the lancing area and was retained for lead analysis. Both the venous and capillary samples were subsequently analyzed with the use of graphite furnace atomic absorption spectrometry (GFAAS). GFAAS of venous blood specimens was considered the reference method of sampling and analysis. We collected and analyzed 126 paired earlobe and venous samples. Earlobe sampling was preferred to venous sampling by 54% of the employees surveyed. The mean difference between the capillary and venous results was 38.8 +/- 48.1 microg/dL. Lead concentrations in earlobe blood were more than twice those found in venous samples in more than half of the samples (64 of 126). Despite simple cleansing with an alcohol wipe and no visible skin contamination, 94% of the wipe samples from earlobes contained more than 1 microg of lead. Even low concentrations of contamination can significantly alter the concentration of lead in the blood; for example, sample contamination of 0.3 microg lead in a 200-microL blood sample would yield an increase of 150 microg/dL in the measured lead concentration. The findings of this study suggest that until satisfactory skin cleansing and decontamination techniques are identified and evaluated, earlobe sampling should be avoided in the surveillance of occupational blood lead levels.
authors.affiliation: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention/DHHS, 4676 Columbia Parkway, MS R-14, Cincinnati, OH 45226-1998, USA. LTaylor@cdc.gov
authors.forename: Lauralynn
authors.initials: L
authors.lastname: Taylor
authors.forename: Robert L
authors.initials: RL
authors.lastname: Jones
authors.forename: Kevin
authors.initials: K
authors.lastname: Ashley
authors.forename: James A
authors.initials: JA
authors.lastname: Deddens
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
mesh_terms: D000328:Adult; D001800:Blood Specimen Collection / Q000379:methods*; D002196:Capillaries / Q000187:drug effects / Q000502:physiology; D004431:Ear, External / Q000098:blood supply; D005260:Female; D006801:Humans; D007854:Lead / Q000097:blood*; D007855:Lead Poisoning / Q000175:diagnosis / Q000517:prevention & control*; D008297:Male; D016273:Occupational Exposure / Q000032:analysis / Q000517:prevention & control*; D016272:Occupational Health; D011159:Population Surveillance / Q000379:methods*
chemical_list: D007854:Lead