Elevated Venous Blood Lead Levels — Primary Care | Children's Hospital of Philadelphia

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Afghan Refugee, ED

Children ≤ 6 yrs with Venous Blood Lead Levels (VBLL)
≥ 3.5 μg/dL Due to Environmental Lead Exposure

VBLL ≥ 45, ED referral
Chelation
Contact Poison Control Center
1-800-222-1222

Laboratory Guidance for Lead Screening

Recommended Actions by VBLL

Medical Management
- Review sources of lead exposure
- Testing for household members
- Iron supplementation, Nutrition Counseling
- Schedule Follow-up Lead Testing
- Patient Education
- Early Intervention Referral as indicated
- Social Work referral for VBLL ≥ 10 μg/dL

Environmental Inspection and Remediation
- All VBLL ≥ 3.5 μg/dl
- Completed by DOH in Philadelphia
- Outside Philadelphia, facilitated by Medicaid insurance case management, if applicable

Ongoing Management
- Follow-up Lead Testing
- Re-assess iron deficiency anemia
- Confirm environmental inspection and remediation if necessary
- Patient Education

Lead level not declining
- Contact insurance company for
  case management
- Keystone First Rapid Response Team
- Health Partners Special Needs Unit
- UHC Bright Futures

Posted: December 2023
Revised: February 2024

Authors:
- E. Huang, MD;
- K. Osterhoudt, MD;
- E. Gregory, MD;
- K. McPeak, MD;
- J. Krzywicki, RN;
- C. Desrochers, MD;
- M. Siddharth, MD;
- B. Gerardi, CRNP;
- K. Thompson, CRNP;
- J. Michel, MD;
- A. Kelley, CRNP;
- J. Carey, RN

Editors: Clinical Pathways Team

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Poison Control Center

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Primary Care Clinical Pathway for Diagnosis and Managementof Elevated Venous Blood Lead Levels

Evidence

CHOP Programs

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Primary Care Clinical Pathway for Diagnosis and Management
of Elevated Venous Blood Lead Levels