Elevated Venous Blood Lead Levels — Primary Care
Laboratory Guidance for Lead Testing
Measuring Lead Levels
CDC Blood Lead Reference Value |
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Capillary Lead Level |
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Venous Blood Lead Level (VBLL) |
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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.