Adult Blood Lead Epidemiology and Surveillance (ABLES)

Reference Blood Lead Levels (BLLs) for Adults in the U. S.

50-60 μg/dL: OSHA’s Medical Removal BLL - The OSHA Lead Standards state that the examining physician has broad flexibility to tailor protections to the worker’s needs.  40 μg/dL: OSHA’s Return to Work 25 μg/dL: OSHA’s NEP – lead (2008) 20 μg/dL: ACGIH Biological Exposure Index (2017)  10 μg/dL: Level for BLL testing every 6 months (AOEC, 2007); California DPH Medical Guidelines (2009); Healthy people 2020, OSH Objective 7 (2010)  5 μg/dL: Case Definition for an elevated BLL: CSTE (2015), ABLES/ NIOSH/CDC (2015), CDC Nationally Notifiable Condition (2016); Level not to exceed during pregnancy: AOEC (2007), California DPH Medical Guidelines (2009), CDC (ACCLPP, 2010) 0.97 μg/dL: 2013-2014 average BLL among adults (National Report on Human Exposure to Environmental Chemicals)

Source Documents for Reference Blood Lead Levels

  1. Occupational Safety and Health Administration (OSHA). Lead StandardsExternal
  2. American Conference of Governmental Industrial Hygienists (ACGIH). Biological Exposure IndicesExternal
  3. OSHA Instruction: National Emphasis Program (NEP) on LeadCdc-pdfExternal“Inspections will also be conducted in establishments where reported employee blood lead levels were at or above 25 μg/dL”
  4. Association of Occupational and Environmental Clinics (AOEC). Medical Management Guidelines for Lead-Exposed Adults, Revised 04/24/2007. CSTE Medical Management Guidelines Added October 2013, see Pages 16-17Cdc-pdfExternal
  5. Kosnett MJ et al. Recommendations for Medical Management of Adult Lead Exposure.External
  6. California Department of Public Health (CDPH) Medical Guidelines for the Lead-Exposed WorkerCdc-pdfExternal
  7. Department of Health and Human Services. Healthy People 2020 Occupational Safety and Health objective 7 (OSH-7External) and operational definitionExternal
  8. Council of State and Territorial Epidemiologists (CSTE) Position Statement 15-EH-01.Cdc-pdfExternal Public Health Reporting and National Notification for Elevated Blood Lead Levels.
  9. Centers for Disease Control and Prevention(CDC), National Institute for Occupational Safety and Health (NIOSH), Adult Blood Lead Epidemiology and Surveillance (ABLES) case definition for an elevated blood lead level
  10. CDC. National Notifiable Diseases Surveillance System (NNDSS). Nationally Notifiable Non-Infectious Conditions. Lead, Elevated Blood Levels 2016 Case Definition
  11. CDC. Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP): Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women Cdc-pdfThese guidelines recommend follow-up activities and interventions beginning at blood lead levels (BLLs) ≥ 5 μg/dL in pregnant women. The essential activity in management of pregnant women with BLLs ≥5 μg/dL is removal of the lead source, disruption of the route of exposure, or avoidance of the lead-containing substance or activity.
  12. National Toxicology Program (NTP). Health Effects of Low-level Lead EvaluationExternal
  13. CDC. National Report on Human Exposure to Environmental Chemicals. Updated tables, January 2017Cdc-pdf
Page last reviewed: March 23, 2018