Recommended Actions Based on Blood Lead Level

Summary of Recommendations for Follow-up and Case Management for Children

CDC recommends testing blood for lead exposure. Two types of blood collection tests may be used:

Child's finger giving blood through a finger prick.

Capillary sample: A finger-prick or heel-prick is used to take a small amount of blood to test for lead.

Blood Lead Test

Venous sample: A small amount of blood is taken after a needle is inserted into the patient’s vein to test for lead.

A patient’s blood lead level (BLL) is measured in micrograms of lead per deciliter of blood (μg/dL). Recommendations are provided for initial screening capillary and confirmed* venous BLLs.

Initial Screening Blood Lead Level

Healthcare providers may use a capillary or venous sample for initial BLL screening. If the capillary results are equal to or greater than CDC’s Blood Lead Reference Value (BLRV), providers should collect a venous sample. If a venous sample was taken during the initial screening test, skip to Confirmed Venous Blood Lead Level.

Confirmed Venous Blood Lead Level

CDC recommends that healthcare providers use a venous draw for confirmatory BLL screening. If the initial screening test used a venous sample, the patient does not need another venous draw.

Table 1: Recommended Schedule for Obtaining a Confirmatory Venous Sample

Recommended Schedule for Obtaining a Confirmatory Venous Sample
Blood Lead Level (μg/dL) Time to Confirmation Testing**
≥3.5–9 Within 3 months
10–19 Within 1 month
20–44 Within 2 weeks
≥45 Within 48 hours

**The higher the BLL is on the initial screening capillary test, the more urgent it is to get a venous sample for confirmatory testing.

Table 2: Schedule for Follow-Up Blood Lead Testinga

Schedule for Follow-Up Blood Lead Testing
Venous blood lead levels (µg/dL) Early follow up testing (2–4 tests after initial test above specific venous BLLs) Later follow up testing after BLL declining
≥3.5–9 3 months* 6–9 months
10–19 1–3 months* 3–6 months
20–44 2 weeks–1 month 1–3 months
≥45 As soon as possible As soon as possible

a Changes in BLLs due to seasonal weather changes may be more apparent in colder climate areas. Greater exposure in the summer months may necessitate more frequent follow ups.

*Some case managers or healthcare providers may choose to repeat blood lead tests on all new patients within a month. Repeated testing may ensure that the patient’s BLL is not rising more quickly than expected.

References

Additional Resources