Biological Factors That Impact Variability of Lead Absorption and Blood Lead Level Estimation in Children: Implications for Child Blood Lead Level Testing Practices
AbstractChildhood lead poisoning in the U.S. continues to be a major unresolved child public health issue. One barrier to solving the problem of lead poisoning concerns current child blood lead level (BLL) monitoring practices. In most states, one or two BLL tests administered in early childhood are used to rule out lead exposure. Current knowledge, however, regarding the multiple, complex biological mechanisms that underlie lead absorption and distribution during development suggests that child BLLs should be assumed to be an informative but necessarily fluctuating metric of current child lead exposure. We review some key mechanisms and pathways that influence lead absorption, lead distribution, and the stability of lead in red blood cells. We also consider how each of these factors and their development are likely to drive fluctuations in child BLLs over time. The goal of this special report is to provide a starting point for change in current child BLL testing practices. Solving the problem of child lead exposure will require new approaches to child BLL testing that take into account likely fluctuations in child BLLs.
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Published: December 2022
- Michelle Del Rio, MPH, PhD, Department of Environmental and Occupational Health, Indiana University–Bloomington
- Christina Sobin, PhD, Department of Public Health Sciences, University of Texas at El Paso
- Ganga Hettiarachchi, PhD, Department of Agronomy, Kansas State University