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of Nebraskans through diagnostic laboratory
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Testing Results
IMPORTANT! Pre-approval needed from state or local health department. Local or State Health Department. Send approval to or call (402) 559-9444.

NPHL has moved to an electronic ordering system, NUlirt, and it is now the preferred method to order all tests. Once ordered, print a "batch list" (see NUlirt Guide).

Forms Required - Nulirt batch list or NPHL Test Request Form (completed in entirety) must accompany the specimen to include the following information: symptoms and date of onset, pregnancy status, travel and vaccine history. Testing will not be performed without all required information.


  Test: Lead, Filter Paper Blood Spot  
  Synonym: Blood Spot Lead 
  Method: Inductively-Coupled Plasma Mass Spectrometry (ICP-MS)  
  Availability: Monday, Wednesday, Friday by 11:00; Monday and Wednesday results in 24 hours and Friday results available the following Monday  
  Specimen: Blood  
  Collection Device: Whole blood spotted on Whatman 903 sample collection paper; circles must be completely saturated through  
  Volume: 3 completely-filled spots  
  Storage/Transport: Ambient  
  Unacceptable: Improperly-collected collection paper, unfilled circles, improper labeling, missing demographic information, contaminated collection paper, rough or wrinkled spot or paper, quantity of sample not sufficient for testing, apparent diluted blood spot, multiple spotting  
  Specimen Stability: 6 months at ambient  
  Reference Interval: < 15 years of age: < 5.0 µg/dL
> 15 years of age: < 25.0 µg/dL

Providers notified of values > 25.0 µg/dL

> 70.0 µg/dL is considered a critical value  
  Reportable Disease:  
  Comments: Samples can be transported through the USPS using pre-addressed tyvek envelopes supplied by Regional Pathology Services. Patient demographic information is required for lead testing including patient full name, address, date of birth, type of specimen, race, reasons for testing, provider name and address, patient insurance or Medicaid billing information, and diagnosis code if applicable.

Collection Procedure:
1. Collection area and materials must be lead free and protected from contamination.
2. Collector must thoroughly wash hands and wear powder-free gloves.
3. Ensure patient's hands are washed and warm. Fingers and hands that are visibly dirty should first be washed with soapy water, rinsed with clean water, and dried with a clean low lint towel preferably plain white with no printed design if using paper towels. Cleanse puncture site with an alcohol wipe and allow to air dry. The puncture site can be prepped using only soap and water as stated above if the use of alcohol is contraindicated.
4. Perform capillary puncture. Use a puncture device that delivers a lacerating puncture, which cuts across the capillary bed. Avoid devices designed for glucose or hemoglobin monitoring where only one drop of blood is needed.
5. Wipe away first drop of blood. Apply gentle pressure to allow a second large drop of blood to form. Lightly touch the printed side of filter paper card to the large blood drop and fill each printed circle with a SINGLE application of blood. Allow the blood to soak through completely filling the circle. Observe the saturation of each printed circle as the blood flows through the filter paper. Do not layer blood spot. Do not touch filter paper to skin. Do not apply blood to both sides of filter pape
6. Label specimen completely with patient's name, DOB, collection date and time, and collectors primary account number found on the blood lead screening requisition.
7. Close the collection device and allow blood specimen to air dry thoroughly on a flat surface. Do not heat or allow the blood spots on the filter paper to touch other surfaces during the drying process.
8. Place dried filter paper along with a complete blood lead requisition in the biohazard transport bag and if using U.S. Mail, place into a Tyvek mailing envelope that is provided by Regional Pathology Services.

Blood Lead Collection Cautions:
1. Failure to allow puncture site to air dry may cause the specimen to be diluted.
2. Milking or squeezing the puncture may cause hemolysis and add mixture of tissue fluids with specimen
3. Do not layer successive drops of blood on the circle spot. If blood flow diminishes to incompletely fill circles repeat the capillary puncture and repeat collection using a new filter paper card.
4. Avoid touching area within circle before collection and blood spots after collection on filter paper. Do not allow water, feeding formulas, antiseptic solutions, etc. to come into contact with the sample.
5. Do not place filter paper in the envelope until thoroughly dry
6. I nsufficient drying can adversely affects test rests

Based on CLSI standard LA4-A5 Blood Collection on Filter paper for Neonatal Screening Programs; Approved Standard-Fifth Edition. 
  Revised: 5/2/2013 


If you have questions about proper specimen collection, please call NPHL Client Services at (402) 559-2440 or toll free at (866) 290-1406.