TABLE 2.

Summary of Recommendations for Children With Confirmed (Venous) Elevated Blood Lead Concentrations16

Blood Lead ConcentrationRecommendations
10–14 μg/dLLead education
    Dietary
    Environmental
Follow-up blood lead monitoring
15–19 μg/dLLead education
    Dietary
    Environmental
Follow-up blood lead monitoring
Proceed according to actions for 20–44 μg/dL if
    A follow-up blood lead concentration is in this range at least 3 months after initial venous test; or
    Blood lead concentration increases
20–44 μg/dLLead education
    Dietary
    Environmental
Follow-up blood lead monitoring
Complete history and physical examination
Lab work
    Hemoglobin or hematocrit
    Iron status
Environmental investigation
Lead hazard reduction
Neurodevelopmental monitoring
Abdominal radiography (if particulate lead ingestion is suspected) with bowel decontamination if indicated
45–69 μg/dLLead education
    Dietary
    Environmental
Follow-up blood lead monitoring
Complete history and physical examination
Lab work
    Hemoglobin or hematocrit
    Iron status
    Free EP or ZPP
Environmental investigation
Lead hazard reduction
Neurodevelopmental monitoring
Abdominal radiography with bowel decontamination if indicated
Chelation therapy
≥70 μg/dLHospitalize and commence chelation therapy
Proceed according to actions for 45–69 μg/dL
Not Recommended at Any Blood Lead Concentration
Searching for gingival lead lines
Evaluation of renal function (except during chelation with EDTA)
Testing of hair, teeth, or fingernails for lead
Radiographic imaging of long bones
X-ray fluorescence of long bones
  • ZPP indicates zinc protoporphyrin.