What is the role of enzyme tests in the workup of lead toxicity?

Updated: Jan 16, 2020
  • Author: Pranay Kathuria, MD, FACP, FASN, FNKF; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Lead inhibits enzymes involved in hemoglobin synthesis and causes elevated FEP and ZPP levels. A FEP or ZPP level may be useful in demonstrating the degree of biologic abnormalities that exist.

FEP and ZPP levels can also be used to help distinguish recent acute lead exposure from chronic exposure. If FEP in normal in the context of high blood lead levels, the exposure is more likely acute; if both are elevated, the exposure is more likely chronic. FEP and ZPP elevation lags behind the blood lead elevation that causes it.

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