Biomonitoring of lead exposure-alternatives to blood.

Lead ( Pb) is one of the most important models for biomonitoring of exposure, with the blood Pb concentration as a predominant choice in practice and in epidemiology. In this article the alternatives for biomarkers to blood are reviewed. This overview focuses on a number of different qualities that are of importance in the evaluation of a biomarker's usefulness and performance. The qualities scrutinized included: (1) analytical accuracy and precision; (2) cost; (3) practical issues; (4) what is reflected by the biomarker; (5) relationship to exposure; and (6) relationship to effects. Data indicate that the best biomarker in some circumstances may be blood, but bone or teeth (for past exposures), feces (for current gastrointestinal exposure), or urine (for organic Pb) are sometimes more useful. A striking feature is that no generally accepted biomarker of bioavailable Pb exists, though plasma, bone, teeth, urine, and hair have all been discussed. For one of the most used applications of blood Pb, monitoring of lead workers' exposure, blood has important shortcomings in that it shows a poor response to changes in exposure at high levels. The alternative of plasma has not been sufficiently evaluated to be considered an alternative in occupational health services, although previous analytical problems are basically overcome. Possibly, urine deserves also more attention. Almost all biomarkers lack systematic data on variation within and between individuals.