Intervention

Blood Lead Level

5-9
µg/dL

10-14
ug/dL

15-19
ug/dL

20-44
ug/dL

45-69
ug/dL

>70
ug/dL

Lead and Nutritional Education

X

X

X

X

X

X

Take Environmental History

X

X

X

X

X

X

Complete medical/nutritional H&P

X

X

X

X

X

X

Evaluate/treat for iron deficiency

X

X

X

X

X

X

Consider starting multi-vitamin

X

X

X

X

X

X

Follow-up blood lead monitoring

X

X

X

X

X

X

Obtain developmental and psychological evaluation

X

 X

X

X

X

Coordinate care with local health department

X

X

X

X

X

Consider chelation / Consult with lead specialist

 X

X

X

Perform urgent chelation

X

X

Hospitalize: medical emergency

X

Monitoring should be based on the most recent venous blood lead level

Venous/Capillary blood lead level (ug/dL)

If Capillary, confirm diagnosis with venous within:

Monitor with a follow up venous blood
Early Follow-up / Late Follow-up
(First 2-4 tests) /  (BLL begins to)
decline

5-9

3 months

3 months**      /    6-9 months

10-19

1 week-1 month*

1-3 months**   /   3-6 months

20-24

1 week-1 month*

1-3 months**  /     1-3 months

25-44

1 week-1 month*

 2 wks-1 month /     1 month  

45-59

48 hours

AS SOON AS POSSIBLE

60-69

24 hours

AS SOON AS POSSIBLE

>70

IMMEDIATELY

AS SOON AS POSSIBLE

^a Seasonal variation of BLLs exists and may be more apparent in colder climate areas.  Greater exposure in the summer months may necessitate more frequent follow ups.

^* The higher the BLL on the screening test, the more urgent the need for confirmatory testing.

^** Some case managers or PCPs may choose to repeat blood lead tests on all new patients within a month to ensure that their BLL is not rising more quickly than anticipated.