Table 3.

Recommended Follow-up Services, According to Diagnostic BLL

BLL (μg/dL)Action
<10No action required
10–14Obtain a confirmatory venous BLL within 1 month; if still within this range,
 Provide education to decrease blood lead exposure
 Repeat BLL test within 3 months
15–19Obtain a confirmatory venous B within this range,
 Take a careful environmental history
 Provide education to decrease blood lead exposure and to decrease lead absorption
 Repeat BLL test within 2 months
20–44Obtain a confirmatory venous BLL within 1 week; if still within this range,
 Conduct a complete medical history (including an environmental evaluation and nutritional assessment) and physical examination
 Provide education to decrease blood lead exposure and to decrease lead absorption
 Either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services
 If BLL is >25 μg/dL, consider chelation (not currently recommended for BLLs <45 μg/dL), after consultation with clinicians experienced in lead toxicity treatment
45–69Obtain a confirmatory venous BLL within 2 days; if still within this range,
 Conduct a complete medical history (including an environmental evaluation and nutritional assessment) and a physical examination
 Provide education to decrease blood lead exposure and to decrease lead absorption
 Either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services
 Begin chelation therapy in consultation with clinicians experienced in lead toxicity therapy
≥70Hospitalize the patient and begin medical treatment immediately in consultation with clinicians experienced in lead toxicity therapy
 Obtain a confirmatory BLL immediately
 The rest of the management should be as noted for management of children with BLLs between 45 and 69 μg/dL