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Classes of Lead Exposure

DCHD Lead Program Response based on CDC Guidelines (May 2012 update)

The following table includes DCHD recommendations (which incorporates the recommendations of the CDC) for various follow-up activities to be ordered by a physician. Please note that a physician may have reasons not to follow these recommendations. However, it is appropriate for you to remind the physician of these recommendations and ask why the additional testing and follow-up is not being done in your child’s case.

 

Blood Lead Level(BLL) Class  DCHD Lead Program Response And Clinic Recommendations
5.0-9.4 ug/dL Class I
  • DCHD – info mailed to home, services offered.
  • Retest yearly until 6 years of age
  • Retest sooner or more often if lead exposure risk increases
  • Children with levels between 5 and 9.4 should have a venous retest within 6 months. However, circumstances may require more frequent testing.

9.5-14.9 ug/dL

Class IIa
  • DCHD case monitoring begins – Family contacted, info mailed to home, services offered
  • DCHD recommends a venous re-test within 1 month for any capillary tests >9.5 and 14.9 µg/dL.
    • NOTE:  If a venous retest can be done within 1 month of an elevated capillary test, it will “confirm” positive exposures and eliminate those children with "false elevated results"
  • When a blood lead level of >9.5  and 14.9 µg/dL is confirmed by a venous test, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family, property owner, and DCHD case monitoring.
  • Clinic should retest within 3 months (venous test recommended)
15-19.9 ug/dL Class IIb  
  • DCHD recommends a venous re-test within 1 month for any capillary tests >15  and 19.9 µg/dL.
    • NOTE:  If a venous retest can be done within 1 month of an elevated capillary test, it will “confirm” positive exposures and eliminate those children with "false elevated results"
  • When a blood lead level of >15  and 19.9 µg/dL is confirmed by a venous test, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family, property owner, and DCHD case monitoring
  • Clinic should retest within 2 months (venous test recommended)
  • Periodic evaluation needed for behavior and developmental impairment and organ impact
20-44.9 ug/dL Class III  
  • DCHD recommends a venous re-test within 1 week for any capillary tests >20  and 44.9 μg/dL.
    • NOTE:  If a venous retest can be done within 1 week of an elevated capillary test, it will “confirm” positive exposures and eliminate those children with “false elevated results"
  • When a blood lead level of >20  and 44.9 μg/dL is confirmed by a venous test, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family, property owner, and DCHD case monitoring
  • Child should be seen by a physician, who evaluates status including oral chelation therapy dependent on BLL, age of child, and length of exposure. A physician will decide which treatment option is appropriate based upon a variety of factors. For information about chelation, click here.
  • Clinic should retest within 1 month (venous test recommended)
  • Long term periodic evaluation needed for behavior and developmental impairment and organ impact
45-69 ug/dL Class IV
  • DCHD recommends a venous re-test within 48 hours for any capillary tests >45  and 69.9 μg/dL.
    • NOTE:  If a venous retest can be done within 48 hours of an elevated capillary test, it will “confirm” positive exposures and eliminate those children with “false elevated results"
  • When a blood lead level of >45  and 69.9 μg/dL is confirmed by a venous test, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family, property owner, and DCHD case monitoring
  • Clinic should retest within 1 month (venous test recommended)
  • Referral to physician for evaluation. The physician will determine the appropriate treatment plan. In many cases treatment will be oral chelation therapy. Click here for more information
  • A blood lead level should be taken immediately after the administration of the chelation mediation to establish trough and one month after to identify rebound. There will be multiple blood tests taken during chelation therapy to monitor the impact of the treatment on the child’s blood lead level. The results of these tests may be used by the physician to adjust the treatment plan. The same blood samples may also be used to monitor organ function.
  • Long term periodic evaluation needed for behavior and developmental impairment; organ impact
 

70 ug/dL and above

Class V  
  • DCHD recommends a venous re-test immediately for any capillary tests >70 μg/dL.
    • NOTE:  If a venous retest can be done within 48 hours of an elevated capillary test, it will “confirm” positive exposures and eliminate those children with “false elevated results"
  • This is considered to be a medical emergency when a blood lead level of >70 μg/dL is confirmed. The child should be admitted to a hospital for evaluation and treatment. Treatment will likely involve chelation therapy. For more information, click here.
  • When a blood lead level of >70 μg/dL is confirmed by a venous test, DCHD visits home, conducts education, risk and environmental assessment, coordinates follow-up with inspector, clinic, family, property owner, and DCHD case monitoring.
  • By law, DCHD should have been notified of the blood lead level by the physician. Laboratory or hospital. DCHD will then coordinate with the treating physician and will conduct an evaluation of the child’s home and for any potential sources of lead contamination prior to the child’s discharge in an effort to make sure that the child will be returning to a lead safe environment.
  • Long term periodic evaluation needed for behavior and developmental impairment and organ impact.

 

Capillary Test: Blood drawn from a finger stick

Venous Test: Blood drawn from a vein in the arm

Based on CDC Guidelines (May 2012 update)

For more information, please call (402) 444-7825

 

 

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