CDC BLOOD LEAD REFERENCE VALUES AND GUIDELINES

Date: 07/20/22

In October 2021, the Centers for Disease Control and Prevention (CDC) decreased the Blood Lead Reference Value (BLRV) to ≥3.5µg/dL. With this decrease, CDC has provided state Lead Poisoning Prevention and Healthy Homes Program with additional guidance for follow-up and case management of children based on initial screening Capillary and Confirmed Venous Blood Lead Levels (BLLs).

Effective March 1, 2022, the Mississippi State Department of Health will begin implementing the new BLRV and CDC recommendations for follow-up below.

Capillary Blood Lead Level*	Time to Confirm with Venous
≥3.5-9 µg/dL	Within 3 months
10-19 µg/dL	Within 1 month
20-44 µg/dL	Within 2 weeks
≥45 µg/dL	Within 48 hours

*Any child identified with a capillary lead level of ≥3.5µg/dL, must receive a confirmatory venous in the time frame shown above based on the blood lead level (BLL).

Based on the confirmatory venous result, a follow-up venous BLL test should be done according to the time frame shown below based on the BLL.

Confirmatory Venous Blood Lead Level	Follow-up Venous Testing
≥3.5-9 µg/dL	3 months**
10-19 µg/dL	1-3 months**
20-44 µg/dL	2 weeks – 1 month
≥45 µg/dL	As soon as possible

**Some providers may choose to repeat blood lead tests on all new patients within a month to ensure the BLL is not rising more quickly than anticipated.

In addition to the confirmatory testing and follow-up guidelines, there is specific anticipatory guidance providers should follow based on the confirmed venous blood lead level.

3.5-19µg/dL

20-44µg/dL

≥45µg/dL

· Report test to MS Lead Poisoning Prevention and Healthy Homes Program (LPPHHP) 6612.pdf (ms.gov)

· Perform routine assessment of physical and mental development per AAP guidelines and nutrition assessment

· Perform structured developmental screenings at child health maintenance visits (Note: Lead’s effect on development may manifest over years.)

· Ensure iron sufficiency via testing and treatment per AAP guidelines

· Provide nutritional counseling related to calcium and iron intake

· Provide anticipatory guidance about common sources of environmental lead exposure

· Make referral for family support based on BLL:

· BLL ≥10 µg/dL refer to Early Intervention

· BLL ≥15 µg/dL refer for home visit and environmental assessment

· F/U BLL monitoring within timeline (See chart above.)

· Report test to MS LPPHHP

· Follow recommendations for BLL 3.5-19 µg/dL and:

Complete history and physical exam assessing for signs and symptoms related to lead
Consider obtaining an abdominal X-ray to evaluate for lead-based paint chips and other foreign bodies
Contact UMMC Poison Control Center for guidance
F/U BLL monitoring within timeline (See chart above.) and continue routine assessment of physical and mental development, including structured developmental screenings at child health maintenance visits (Note: Lead’s effect on development may manifest over years.), per AAP/Bright Futures guidelines, anticipatory guidance, and nutrition counseling

· Report test to MS LPPHHP

· Follow recommendations for BLL 20-44 µg/dL and:

Complete history and physical exam including detailed neurological exam
Obtain abdominal X-ray to evaluate for lead-based paint chips and other foreign bodies and initiate bowel decontamination, if indicated
Contact UMMC Poison Control Center for guidance
F/U BLL monitoring within timeline (See chart above.) and continue routine assessment of physical and mental development, including structured developmental screenings at child health maintenance visits (Note: Lead’s effect on development may manifest over years.), per AAP/Bright Futures guidelines, anticipatory guidance, and nutrition counseling

Please contact the MS State Department of Health Lead Poisoning Prevention and Healthy Homes Program at 601-576-7447 if there are questions or concerns about the information shared above.