How To Respond To An Elevated Test

BLL Test Results

(μg/dL)

Venous Confirmation -Retest Within Recommended Actions based on BLL Venous Retest –

After Recommended Actions

< 5 None •   Provide dietary counseling (calcium & iron) and environmental education

•   Follow-up blood lead monitoring at recommended intervals

Retest according to

Blood Lead Screening Plan

5 – 9 3 mo Above Actions, plus:

•       Complete history and physical exam

•       Lab work: iron status, hemoglobin, hematocrit

•       Refer to health department for environmental investigation

•       Recommend lead hazard reduction in home

•       Neurological, behavioral, and developmental monitoring

•       Abdominal x-ray (if lead ingestion is suspected with bowel decontamination)

•       Environmental assessment to identify potential lead sources

3 months for first 2 – 4 tests

6 – 9 months after BLL are declining

10 – 19 1 – 3 mo 1 – 3 months for first 2 – 4 tests

3 – 6 months after BLL are declining

20 – 24 1 – 3 mo 1 – 3 months for first 2 – 4 tests

1 – 3 months after BLL are declining

25 – 44 2 wk – 1 mo 2 weeks – 1 month for first 2 – 4 tests

1 month after BLL are declining

45 – 59 ASAP

48 hours

Above Actions, plus:

•   Environmental investigation of the home and lead hazard reduction

•   Oral chelation therapy

•   Consider hospitalization if lead-safe environment cannot be assured

Every 24 hours

or as medically indicated

Every 24 hours

or as medically indicated

60 – 69 ASAP

24 hours

≥ 70 Stat as emergency test Above Actions, plus:

•   Hospitalize and commence chelation therapy in conjunction with consultation from a medical toxicologist or a pediatric environmental health specialty unit

Every 24 hours

or as medically indicated

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