Blood Lead Level (BLL)

Class

DCHD Lead Program Response

And Clinic Recommendations

0 - 9 ug/dL

capillary or venous

Class l

• 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 begins - 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 week

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 evaluate home and environment for lead exposure prior to child's discharge.
• Retest and retreat as appropriate
• Periodic evaluation needed for behavior and developmental impairment.

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