Organ Weight Reference Ranges for Ages 0 to 12 Years.

Abnormal organ weights often serve as an indicator of underlying disease or other pathological process making assessment of organ weight a critical part of the autopsy examination and interpretation. Unfortunately, normal organ weights for children are often based on studies done in the 1930s and 1960s. Thus, the present study was designed to accurately assess organ weights in children to establish reference ranges for use in autopsy examinations. A total of 1759 traumatic deaths in children aged 0 to 12 years were reviewed. Analysis revealed that body length was the best predictor for organ weight. Reference ranges were established and stratified by both age and body length.

LAMP: A CDC Program to Ensure the Quality of Blood-Lead Laboratory Measurements.

CONTEXT: The Lead and Multielement Proficiency (LAMP) program is an external quality assurance program promoting high-quality blood-lead measurements. OBJECTIVES: To investigate the ability of US laboratories, participating in the Centers for Disease Control and Prevention (CDC) LAMP program to accurately measure blood-lead levels (BLL) 0.70 to 47.5 µg/dL using evaluation criteria of ±2 µg/dL or 10%, whichever is greater. METHODS: The CDC distributes bovine blood specimens to participating laboratories 4 times per year. We evaluated participant performance over 5 challenges on samples with BLL between 0.70 and 47.5 µg/dL. The CDC sent 15 pooled samples (3 samples shipped in 5 rounds) to US laboratories. The LAMP laboratories used 3 primary technologies to analyze lead in blood: inductively coupled plasma mass spectrometry, graphite furnace atomic absorption spectroscopy, and LeadCare technologies based on anodic stripping voltammetry. Laboratories reported their BLL analytical results to the CDC. The LAMP uses these results to provide performance feedback to the laboratories. SETTING: The CDC sent blood samples to approximately 50 US laboratories for lead analysis. PARTICIPANTS: Of the approximately 200 laboratories enrolled in LAMP, 38 to 46 US laboratories provided data used in this report (January 2017 to March 2018). RESULTS: Laboratory precision ranged from 0.26 µg/dL for inductively coupled plasma mass spectrometry to 1.50 µg/dL for LeadCare instruments. All participating US LAMP laboratories reported accurate BLL for 89% of challenge samples, using the ±2 µg/dL or 10% evaluation criteria. CONCLUSIONS: Laboratories participating in the CDC's LAMP program can accurately measure blood lead using the current Clinical Laboratory Improvement Amendments of 1988 guidance of ±4 µg/dL or ±10%, with a success rate of 96%. However, when we apply limits of ±2 µg/dL or ±10%, the success rate drops to 89%. When challenged with samples that have target values between 3 and 5 µg/dL, nearly 100% of reported results fall within ±4 µg/dL, while 5% of the results fall outside of the acceptability criteria used by the CDC's LAMP program. As public health focuses on lower blood lead levels, laboratories must evaluate their ability to successfully meet these analytical challenges surrounding successfully measuring blood lead. In addition proposed CLIA guidelines (±2 µg/dL or 10%) would be achievable performance by a majority of US laboratories participating in the LAMP program.

Determination of Iodine Content in Dairy Products by Inductively Coupled Plasma Mass Spectrometry.

A probing study to establish a reliable and robust method for determining the iodine concentration using the ELAN® DRC™ II ICP-MS was performed in combination with a sample digestion and filtration step. Dairy products from locally available sources were evaluated to help determine the possibility and need for further evaluations in relation to the U.S. population's iodine intake. Prior to analysis, the samples were aliquoted and digested for 3 hours at 90±3 °C. Dilution and filtration were performed, following the digestion. The sample extract was analyzed, and the results were confirmed with NIST SRM 1549a Whole Milk Powder. Further experimentation will need to be performed to optimize the method for projected sample concentration and throughput.

Testing an Age-old Adage: Can Autopsy Findings be of Assistance in Differentiating Opioid Versus Cardiac Deaths?

Given the common occurrence of both opioid and cardiovascular deaths, and the concomitant use of opioids in those with cardiac disease, the present study was undertaken to see whether the old adage of using the triad of cerebral and pulmonary edema and bladder fullness to suggest an opioid death could be used to differentiate deaths due to opioid toxicity from deaths due to cardiac disease. Brain weight, lung weight, and bladder fullness were compared among opioid-related deaths, cardiac deaths, and a control population. It was found that opioid-related deaths were more likely to have heavy lungs, a heavy brain, and a full bladder, while cardiac-related deaths had smaller volumes of urine in the bladder and heavier hearts. In conjunction with a thorough investigation, these findings may be useful to forensic pathologists when determining whether a death is opioid-related, especially in the setting of concomitant cardiac disease.

Measurement Challenges at Low Blood Lead Levels.

In 2012, the Centers for Disease Control and Prevention (CDC) adopted its Advisory Committee on Childhood Lead Poisoning Prevention recommendation to use a population-based reference value to identify children and environments associated with lead hazards. The current reference value of 5 µg/dL is calculated as the 97.5th percentile of the distribution of blood lead levels (BLLs) in children 1 to 5 years old from 2007 to 2010 NHANES data. We calculated and updated selected percentiles, including the 97.5th percentile, by using NHANES 2011 to 2014 blood lead data and examined demographic characteristics of children whose blood lead was ≥90th percentile value. The 97.5th percentile BLL of 3.48 µg/dL highlighted analytical laboratory and clinical interpretation challenges of blood lead measurements ≤5 µg/dL. Review of 5 years of results for target blood lead values <11 µg/dL for US clinical laboratories participating in the CDC's voluntary Lead and Multi-Element Proficiency quality assurance program showed 40% unable to quantify and reported a nondetectable result at a target blood lead value of 1.48 µg/dL, compared with 5.5% at a target BLL of 4.60 µg/dL. We describe actions taken at the CDC's Environmental Health Laboratory in the National Center for Environmental Health, which measures blood lead for NHANES, to improve analytical accuracy and precision and to reduce external lead contamination during blood collection and analysis.