Managing elevated blood lead levels:
a guide for clinicians
Principles of management
Who should be screened for elevated blood levels (BLL)?
Please refer to the fact sheet ‘Who should be screened for elevated blood lead levels?’
Confirmation of elevated levels
An elevated BLL must be confirmed as the finding of elevated levels might mean
considerable disruption to the affected household. The section below on medical
management provides more information on when to re-test.
Management of acute lead poisoning
For management of urgent symptomatic cases please contact the WA Poisons Information
Centre 13 11 26 (all hours). Acute lead poisoning with overt symptoms is now rare in
Western Australia; most cases identified will be subclinical elevated levels due to chronic
exposure picked up on screening.
Multi-disciplinary approach
The mainstay of managing elevated BLL is identifying and removing the source, reducing
lead absorption in an exposed individual, providing information and education to affected
individuals and families and careful follow-up to ensure that management is successful. This
requires communication between hospitals, the general practitioner, environmental health
and the households affected.
High risk groups
The following groups are particularly vulnerable to the adverse effects of lead and their
management should be prioritised;

Children (especially those under the age of 5 years)

Pregnant women

Lactating women
In all cases of an elevated BLL (5 µg/dL and above for high-risk groups and 10 µg/dL and
above for everyone else):



Notify the Executive Director of Public Health (EDPH) within 3 days using the
electronic ‘Notification of Lead Poisoning’ notification form or fill out a printed form and
fax or post this to the EDPH.
Discuss the case with a clinical toxicologist
The Environmental Health Directorate is able to provide assistance and information
with assessing exposure using the lead exposure questionnaire, carrying out
abatement and screening of household contacts. (9388 4999 ask for a toxicologist)
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Managing elevated blood lead levels: A guide for clinicians

continued
Provide information to the affected household on reducing exposure and absorption of
lead (see the fact sheet ‘Reducing your blood lead levels’).
Medical management of elevated BLL
For neonates aged less than 1 month, re-test initially within one month.
In all cases of an elevated BLL:



Remove the exposure or the person from the exposure, whichever is more practicable
and provide advice on reducing lead absorption.
Repeat blood lead levels six weeks to three months after abatement and then again at six
months.
Test for iron-deficiency anaemia and manage this accordingly.
For a BLL of less than 50 µg/dL, the mainstay of treatment is reducing exposure. A BLL of 50
µg/dL and above is likely to require admission and chelation therapy. Consult with a clinical
toxicologist.
Elevated BLL in pregnancy


Management and re-testing should be carried out in consultation with experts in lead
toxicity and high-risk pregnancies.
Immediate removal from the lead source is the priority in all cases where BLL is equal to
or greater than 5 µg/dL.
Elevated BLL and breast-feeding



Management and re-testing of mother and child should be carried out in consultation with
a paediatrician and a clinical toxicologist.
In general, initiation of breast-feeding is encouraged if maternal BLL is less than 40 µg/dL
Breast-feeding should continue if the infant’s BLL is less than 5 µg/dL
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