Patient preferences were not discussed. Background papers providing critical appraisal of the evidence and tentative recommendations prepared by the chapter author were pre-circulated to the members. Consensus was reached on final recommendations. Benefits, Harms, and Costs Blood lead concentrations do not necessarily represent lead toxicity. Although blood tests for lead have good precision and accuracy, they cannot differentiate between a recent exposure to a high level of lead or chronic exposure resulting in a steady state.
Costs are also high and the test is slow and cumbersome.
Erythrocyte Protoporphyrin measurement is inexpensive, unaffected by environmental lead contamination, is easily done on capillary blood specimens, and is a better indicator of chronic lead exposures. Questionnaires have not been tested for detection of lead. EDTA chelation therapy and penicillamine reduce moderate lead levels in the short term. No controlled trials of nutritional interventions have been done. Adverse effects of drug therapy are present for all therapies although succimer and penicillamine have lower levels.