Elevated Venous Blood Lead Levels — Primary Care | Children's Hospital of Philadelphia

Goals and Metrics

VBLL ≥ 45, ED referral
Chelation
Contact Poison Control Center
1-800-222-1222

Laboratory Guidance for Lead Screening

Recommended Actions by VBLL

Medical Management
- Review sources of lead exposure
- Testing for household members
- Iron supplementation, Nutrition Counseling
- Schedule Follow-up Lead Testing
- Patient Education
- Early Intervention Referral as indicated
- Social Work referral for VBLL ≥ 10 μg/dL

Environmental Inspection and Remediation
- All VBLL ≥ 3.5 μg/dl
- Completed by DOH in Philadelphia
- Outside Philadelphia, facilitated by Medicaid insurance case management, if applicable

Ongoing Management
- Follow-up Lead Testing
- Re-assess iron deficiency anemia
- Confirm environmental inspection and remediation if necessary
- Patient Education

Lead level not declining
- Contact insurance company for
  case management
- Keystone First Rapid Response Team
- Health Partners Special Needs Unit
- UHC Bright Futures

Posted: December 2023
Revised: February 2024

Authors:
- E. Huang, MD;
- K. Osterhoudt, MD;
- E. Gregory, MD;
- K. McPeak, MD;
- J. Krzywicki, RN;
- C. Desrochers, MD;
- M. Siddharth, MD;
- B. Gerardi, CRNP;
- K. Thompson, CRNP;
- J. Michel, MD;
- A. Kelley, CRNP;
- J. Carey, RN

Editors: Clinical Pathways Team

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Primary Care Clinical Pathway for Diagnosis and Management
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Elevated Venous Blood Lead Levels — Primary Care

Primary Care Clinical Pathway for Diagnosis and Managementof Elevated Venous Blood Lead Levels

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Primary Care Clinical Pathway for Diagnosis and Management
of Elevated Venous Blood Lead Levels