Blood Lead Case Management

Retesting Recommendations

<5 mcg/dL
  • Repeat the blood lead level in 6-12 months if the child is at high risk or risk changes during the timeframe.
  • Ensure levels are done at 1 and 2 years of age.
  • If child is <12 months, consider retesting in 3-6 months as lead exposure may increase as motility increases.
5-14 mcg/dL
  • Retest venous blood lead levels within 1-3 months to ensure the lead level is not rising. 
  • If it is stable or decreasing, retest venous blood lead level in 3 months. 
15-44 mcg/dL
  • Confirm the blood lead level with repeat venous sample within 1-4 weeks.
>44 mcg/dL
  • Confirm the blood lead level with repeat venous sample within 48 hours.

Recommended Screenings

<5 mcg/dL
  • Perform routine health maintenance assessment including assessment of nutrition, physical and mental development, as well as iron deficiency risk factors.
  • Provide anticipatory guidance on common sources of environmental lead exposure: paint in homes built prior to 1978, soil near roadways and other sources of lead, take-home exposures related to adult occupations, imported spices, cosmetics, folk remedies and cookware.  Refer to Lead Educational Resources For Parents/Guardians.
5-14 mcg/dL
  • Take a careful home environmental history using the Case Investigation Form to identify possible sources of exposure. Follow faxing instructions. Provide preliminary advice about reducing/eliminating exposures and consider other children who may be exposed. 
  • Ensure iron sufficiency with adequate laboratory testing (CBC, Ferritin, CRP).
  • Consider starting a multivitamin with iron. If using an iron supplement ensure patient is drinking a glass of orange juice (not fortified with calcium) when taking the supplement to increase absorption.
  • Provide nutritional counseling related to calcium and iron. In addition, recommend having a fruit at every meal as iron absorption quadruples when taken with Vitamin C-containing foods. Encourage the consumption of iron-enriched foods (e.g., cereal, meat) and green leafy vegetables: spinach, chard, kale, mustard greens, collard greens, cabbage, broccoli, romaine and arugula.  Refer to Lead Educational Resources For Parents/Guardians.
  • Perform structured developmental screening evaluations at child health maintenance visits, as lead's affect on development may manifest over years. 
15-44 mcg/dL
  • Perform steps as described above for levels 5-14 mcg/dL.
  • Additionally, specific evaluation of the child, such as abdominal xray should be considered based on the environmental investigation and history (e.g., pica for paint chips, mouthing behaviors). Any treatment should be done in consultation with an expert. Contact local PEHSU or PCC for guidance.
>44 mcg/dL
  • Follow guidance for BLL 15-44 mcg/dL as listed above.
  • Consider hospitalization and/or chelation therapy (managed with the assistance of an experienced provider). Contact your regional PEHSU or PCC for assistance. 

*Content from PEHSU's Recommendations for Medical Management for Childhood Lead Exposure and Poisoning and Department of Health's Expert Panel Childhood Lead Screening Guidelines.