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Common Test-Ordering Errors
Part 5: Overordered Tests

Plasma Thiamin
Serum Folate
Zinc Protoporphyrin (ZPP)



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Heme Synthesis*

Slide 11

August 2010

Before blood lead assays were widely available, red blood cell zinc protoporphyrin was used as an indicator of lead toxicity. That test works because lead inhibits several enzymes in the heme synthesis pathway, including the last step, which is catalyzed by the enzyme ferrochetolase. In the presence of lead-induced inhibition, protoporphyrin intermediates accumulates within the RBC; thus, RBC zinc protoporphyrin is a marker for lead toxicity.

Heme Synthesis*

 


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