Elevated Venous Blood Lead Levels — Primary Care

Laboratory Guidance for Lead Testing

Measuring Lead Levels

CDC Blood Lead Reference Value
  • 2012 CDC reference value ≥ 3.5 ug/dL
  • Identifies children with higher lead levels than most children
  • Based on 97.5th percentile of blood levels in children 1-5 yrs from 2015 to 2016
Capillary Lead Level
  • Obtained by finger-prick
  • Used to screen for elevated lead levels
  • Results may be falsely elevated due to lead on the skin or in the environment
  • Confirmatory testing is required; refer to recommended timeframe for testing
Venous Blood Lead Level (VBLL)
  • Used to confirm all capillary blood lead level results greater than CDC reference value
  • Refer to recommended timeframe for VBLL based on lead elevation
  • ED Referral Required
  • Capillary levels ≥ 45 ug/dL for urgent confirmation to guide need for treatment
    • Send CBC, ferritin and CMP

Timeframe for Obtaining a Confirmatory Venous Sample
Based on Capillary Lead Level

Capillary BLL (μg/dL) Time to Venous Sample
3.5-9.9 Within 3 mos
10-19.9 Within 1 mo
20-44.9 Within 2 wks
≥ 45 Refer to ED for urgent confirmation

Timeframe for Obtaining Repeat Venous Blood Lead Level

Continue testing until VBLL ≤ 3.5 µg/dL

Initial VBLL (µg/dL) Frequency of the First 2-4 Tests
Until Level is Declining
Follow-up Testing After
Venous BLL Declining
3.5-9.9 3 mos 6-9 mos
10-19.9 1-3 mos 3-6 mos
20-44.9 2 wks to 1 mo 1-3 mos
≥ 45 As soon as possible As soon as possible

Reference

Recommended Actions Based on Blood Lead Level  

Recommended Actions by Venous Blood Lead Level

Perform the following actions to prevent long-term health issues associated with elevated VBLL.

VBLL 3.5-9.9 μg/dL 10-19.9 μg/dL 20-44.9 μg/dL ≥ 45 μg/dL
Re-check VBLL In 3 mos 1-3 mos 2 wks to 1 mo Refer to ED
Multivitamin with Iron; or Ferrous Sulfate if Iron-deficiency is Identified
Nutrition Assessment and Counseling (WIC/SNAP Needs)
Test Additional Household Members
Patient Education
Contact Department of Health
Home Environmental Lead Inspection
Early Intervention Referral If developmental concerns noted
Referral to Social Work Team for Lead Mitigation Support
Abdominal X-ray*
Chelation
Contact Poison Control for Chelation Guidance

*Consider abdominal radiograph for higher VBLLs to assess intestinal lead burden, especially if concern for ongoing ingestion of lead paint chips or other lead foreign bodies.