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Hemachemistry: Childhood Blood Lead Testing in North Carolina

Blood Lead Teleform Implementation at the State Lab (PDF, 198 KB)

Blood lead testing is encouraged as an important element of a comprehensive program to eliminate childhood lead poisoning. The goal of such testing is to identify children who need individual interventions to reduce their exposure.

The Centers for Disease Control and Prevention (CDC) recommend a blood lead test be performed on all children at ages 1 and 2 years and on children ages 36-72 months who have not been screened previously. Lead has no known physiological value and children are particularly susceptible to its toxic effects. Most affected children have no apparent symptoms, and consequently, many cases go undiagnosed and untreated.

Direct blood lead measurement is the screening test of choice. Finger-stick, capillary blood specimens are adequate for the initial screening test, provided that precautions are taken to minimize the risk of contamination. Venous blood specimens should be collected for confirmation of all elevated blood lead results. The North Carolina State Laboratory of Public Health (NCSLPH) will analyze blood lead specimens for children less than six years of age and refugee children through 16 years of age. On average, the NCSLPH performs testing on > 100,000 specimens annually using ICP-MS (Inductively Couple Plasma Mass Spectrometer) technology.

The NCSLPH now performs prenatal lead testing in partnership with local public health departments (LHDs) in North Carolina. Prenatal care patients seen in clinics that meet the required criteria assessed using the DHHS 4116 - Lead and Pregnancy Risk Questionnaire will be eligible for this testing. Please be advised that the required specimen type for adult lead testing is a venipuncture specimen (rather than fingerstick) collected in a lavender-top blood collection tube.

NCSLPH will not process blood lead specimens collected on patients who are not residents of North Carolina. If any serious elevations were detected, the North Carolina Childhood Lead Poisoning Prevention Program would not have any jurisdiction in another state.

North Carolina's Recommended Guidelines and Requirements for Childhood Blood Lead Testing

  1. Health care providers are encouraged to conduct a blood lead test on all children at 12 months and again at 24 months of age.
  2. All children participating in Health Check (Medicaid), Health Choice or the Special Nutrition Program for Women, Infants and Children (WIC Program) are required to receive a blood lead test at 12 and 24 months of age.
  3. All refugee children 6 months to 16 years of age are to be tested at the time of arrival in the United States and again three to six months after placement in a permanent residence regardless of initial test results.

Hemachemistry Information