Classes of Lead Exposure

0 - 9 ug/dL

capillary or venous

Class I

• Safest level, retest yearly until 6 years of age (low risk - 3 years of age)
• Retest sooner or more often if lead exposure risk increases 
• If immediate prior BLL ≥ 10, retest 6 months to monitor continued exposure
  

10 - 14 ug/dL

capillary or venous

Class IIa

• DCHD case management beings - info mailed to home, services offered
• Clinic should retest within 3 months, capillary or venous BLL
  

15 - 19 ug/dL

if capillary, confirm with venous within 1 month

Class IIb

• When confirmed, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family and DCHD case management
• Clinic should retest in 2 months with venous BLL
• Periodic evaluation needed for behavior and developmental impairment
  

20 - 44 ug/dL

if capillary, confirm with venous within 1 month

Class III

• When confirmed DCHD visits home (above)
• Child referred to physician who evaluates status and may consider oral chelation dependent on BLL, age of child and length of exposure
• Clinic should retest in 1 month with venous BLL
• Periodic evaluation needed for behavior and developmental impairment
  

45 - 69 ug/dL

if capillary, confirm with venous within 48 hours

Class IV

• When confirmed, DCHD visits home (above)
• Referral to physician for evaluation and oral chelation
• Retest after chelation to establish trough (immediate S/P medication) and rebound (1 mo. S/P medication) BLL; retest and retreat as appropriate
• Periodic evaluation needed for behavior and developmental impairment
  

≥ 70 ug/dL

if capillary, redraw venous STAT

Class V

• Medical Emergency - child admitted for observation pending results of confirmation or hospitalized for evaluation and IV or IM chelation 
• DCHD must evaluation home and environment for lead exposure prior to child's discharge
• Retest and retreat as appropriate
• Periodic evaluation needed for behavior and developmental impairment