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For Healthcare Providers
For Healthcare Providers
BLOOD LEAD REFERENCE VALUE UPDATE
On October 28, 2021, The Centers for Disease Control and Prevention (CDC) updated the blood lead reference value (BLRV) from 5 µg/dL to 3.5 µg/dL (MMWR 2021). As of May 1, 2022, State of Michigan Medicaid policy will align with this update (MDHHS Health and Aging Services Administration Bulletin 22-11). The blood lead reference value is based on the 97.5th percentile of the blood lead distribution in U.S. children ages 1-5 years from the National Health and Nutrition Examination Survey.
No level of lead in the blood is safe, and MDHHS welcomes the update of the BLRV for clinical management and public health response for children with lead exposure. As outlined in updated guidance from the CDC, American Academy of Pediatrics, and the Pediatric Environmental Health Specialty Units, health care providers should begin providing follow-up testing and other recommended actions for children with BLL ≥ 3.5 µg/dL.
- MDHHS Pediatric Blood Lead Level Quick Reference for Primary Care Providers
- MMWR Update of the Blood Lead Reference Value - United States, 2021 | MMWR (cdc.gov)
- CDC Recommended Actions Based on Blood Lead Level CDC - Lead - Recommended Actions Based on Blood Lead Levels
- PEHSU Factsheet Recommendation on Management of Lead Exposure Articles - PEHSU
- AAP Press Release Lower blood lead reference level doesn't change clinical management | American Academy of Pediatrics (aappublications.org)
- Update of Blood Lead Reference Value and Recommendations on the Medical Management of Childhood Lead Exposure MDHHS Health and Aging Services Administration Bulletin 22-11 | (Michigan.gov)
POINT-OF-CARE BLOOD LEAD TESTING LEADCARE TEST KIT RECALL
March 30, 2022 Update: The U.S. Food and Drug Administration (FDA) posted an update that Magellan Diagnostics has resumed distribution of LeadCare II test kits. There are previously distributed recalled test kit lots that are still in circulation and the recall continues to apply to those lot numbers.
To see lots included in the recall and recommendations related to recalled test kits, go to Magellan Diagnostics Recalls LeadCare II, LeadCare Plus, and LeadCare Ultra Blood Lead Tests Due to Risk of Falsely Low Results (FDA.gov).
Other options for blood lead testing include:
- Venous sampling
- Capillary microtainer sampling (screening only, all elevated capillary samples require venous confirmatory testing)
Sample processing is available through the Michigan Department of Health and Human Services Trace Metals Lab as well as many clinical laboratories.
LeadCare Blood Lead Test Kit Recall Resources
- Magellan Diagnostics Recalls LeadCare II, LeadCare Plus, and LeadCare Ultra Blood Lead Tests Due to Risk of Falsely Low Results (FDA.gov)
- Information on the LeadCare Test Kit "Controls Out of Range-Low" Recall (Magellandx.com)
Healthcare providers play an important role in preventing primary lead exposure, as well as identifying children that are at risk of blood lead poisoning.
Blood lead testing recommendations for children
If a health care provider determines that a child is at risk for lead poisoning, testing is necessary. In Michigan, a blood lead level of 3.5 µg/dL or higher is considered elevated. At a level of 3.5 µg/dL or greater, lead education, environmental investigations, and additional medical monitoring should be established to lower the blood lead level.
At a level of 45 µg/dL or greater, any treatment should be performed in consultation with Michigan's Poison Control Center. Hospitalization and/or chelation should be considered. Other children who may have also been exposed should be tested. The family should NOT return to the lead-contaminated home.
Blood lead testing recommendations for pregnant persons
If a healthcare provider determines a pregnant person is at risk for lead poisoning, testing is necessary. Routine blood lead testing is not recommended for all pregnant or nursing persons. A blood lead risk assessment should be done to determine if testing is needed. This risk assessment can be found on the back of the Pregnant and Nursing Persons Factsheet.
Blood lead testing recommendations for workers
The Michigan Occupational Safety and Health Administration (MIOSHA) has established lead standards for workers in general industrial and construction jobs. Both standards define minimum safety precautions, including regular testing, that employers must provide for employees exposed to lead on the job.
Michigan Care Improvement Registry (MCIR)
The Blood Lead Module is a component of a patient's MCIR record. If the patient has had a blood lead test, the results will be displayed in the record, as well as how to interpret the results with corresponding recommended actions. If a patient lives within zip codes where childhood lead poisoning is more prevalent or lived in Flint during the Flint Water Crisis, additional alerts will be displayed indicating that the patient is at high risk and their blood lead levels should be monitored.