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Blood Lead Case Management

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Retesting and screening recommendations for healthcare providers

If you believe your pediatric patient has been exposed to lead, we can help. Follow this guidance for proper test and retest intervals and to assess environmental risk factors.

When do I need to retest?

<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.
  • Get blood lead levels at one and two years of age.
  • If the child is younger than one, consider retesting in three to six months as lead exposure may increase as the child’s mobility increases.

5-14 mcg/dL

  • Retest venous blood lead levels within one to three months to ensure the lead level is not rising.
  • If it is stable or decreasing, retest blood lead level in three months.

15-44 mcg/dL

  • Confirm the blood lead level with repeat sample within one to four weeks.

>44 mcg/dL

  • Confirm the blood lead level with repeat sample within 48 hours.

Recommended screenings

<5 mcg/dL

  • Perform routine health maintenance assessment to measure nutrition, physical and mental development, as well as iron deficiency risk factors.
  • Provide guidance on common sources of environmental lead exposure: paint in homes built before 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 to reduce or eliminate exposures and to 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 fruit with 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 effect on development may manifest over years.

15-44 mcg/dL

>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 Washington State Department of Health's Expert Panel Childhood Lead Screening Guidelines.

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