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06/10/2009
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 Blood Lead Update August 10, 2004 BLOOD LEAD UPDATE Lead poisoning continues to be a major childhood health problem world wide. A significant number of children acquire lead poisoning within the first year of life. This harmful condition can be prevented or it effects reversed, but if must first be identified. In recent decades, lead exposure has significantly decreased in the general population. However, risk of lead exposure continues to be associated with low socioeconomic status. The primary source of exposure in children continues to be ingestion of paint chips or dust containing lead. Prior to 1972, household paint contained significant amounts of lead. It is estimated that a single chip of paint can contain as much as 10,000 micrograms of lead and, when ingested, children will absorb up to 50% of the lead. Common symptoms of low lead toxicity include decreased IQ, hearing and growth. High level toxicity symptoms include anemia, nephropathy and encephalopathy. Aggressive medical intervention is recommended in these cases. In response to the continuing lead exposure problem, the State of Michigan has increased its screening goal of pediatric patients from the current 40% recommendation to 80% by 2006. In response, PHP has encouraged increased screening levels by providing an incentive to increase pediatric screening levels to 50%. Recently the State Department of Community Health has upgraded its required Blood Lead Analysis report. This report is required by the state and is sent to them when testing is complete. If you are collecting blood lead samples in your office or hospital and are submitting them to RML, please include one of these forms with the sample. The information you are required to submit includes items in the top three boxes on the form. RML will complete the fourth box and submit the completed form to the state. A copy of this form is attached. Additional forms may be obtained from RML. Ask for form #175. Also, attached is The American Academy of Pediatrics Blood Lead Management Table. Regional Medical Laboratories has, for many years, provided onsite lead testing for its southern Michigan clients. We provide the latest in blood lead technology with rapid turn around times. If you have any questions or comments regarding lead testing, please contact Ken VandenBosch at our Central Lab testing facility. Recommended Follow-up Services, According to Diagnostic Blood Lead Level (BLL) BLL (ug/dL) Action < 10 No action required. 10 - 14 Obtain a confirmatory venous BLL within 1 month. If still within this range, provide education to decrease blood lead exposure, and repeat BLL test within 3 months. 15 - 19 Obtain a confirmatory venous BLL within 1 month. If still within this range, take a careful environmental history, provide education to decrease blood lead exposure and to decrease lead absorption, and repeat BLL test within 2 months. 20 - 44 Obtain a confirmatory venous BLL within 1 week. If still within this range, conduct a complete medical history (including an environmental evaluation and nutritional assessment) and physical examination, provide education to decrease blood lead exposure and to decrease lead absorption, and either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services. If BLL is > 25 ug/dL, consider chelation (not currently recommended for BLLs < 45 ug/dL) after consultation with clinicians experienced in lead toxicity treatment. 45 - 69 Obtain a confirmatory venous BLL within 2 days. If still within this range, conduct a complete medical history (including an environmental evaluation and nutritional assessment) and physical examination, provide education to decrease blood lead exposure and to decrease lead absorption, and either refer the patient to the local health department or provide case management that should include a detailed environmental investigation with lead hazard reduction and appropriate referrals for support services. Begin chelation therapy in consultation with clinicians experienced in lead toxicity treatment. >or = to 70 Hospitalize the patient and begin medical treatment immediately in consultation with clinicians experienced in lead toxicity therapy. Obtain a confirmatory BLL immediately. The rest of the management should be as noted for management of children with BLLs between 45 and 69 ug/dL. |
