Adult Lead For Health Professionals

Lead and Your Adult Patients

  • Ninety-four percent of adults with elevated blood lead levels (BLLs) are exposed to lead in the workplace.
  • Workers may also expose their families to lead by bringing lead dust home from their workplace. Approximately 2-3 percent of children with BLLs of 10 µg/dL or more were exposed to lead this way.
  • Learn more about what can be done to help protect your patients and their families.

What Health Care Providers Can Do

Ask about your patient's work at every visit.

Many of your patients work more than one job or change jobs or job tasks often. Here are a few basic questions:

  • What type of work do you do? What kind of company do you work for?

  • What are your usual job tasks? How much time do you spend doing each task? What kinds of hazards do you encounter?

  • Do you use any personal protective equipment (PPE) (e.g., gloves, respirators)? For what tasks do you use PPE?

  • Do you think your health problems may be related to work?

  • Are you currently exposed to chemicals, dusts, or metals that may contain lead? Have you been exposed in the past?

  • Are any of your co-workers experiencing similar symptoms?

  • Do you have any hobbies that involve working with lead such as casting bullets or fishing sinkers, home remodeling, target shooting at firing ranges, stained glass making, or auto repair?

Talk to your patients about being tested for lead poisoning.

Recommend testing of household members if your patient's BLL is 5 µg/dL or higher.

Pay special attention to working patients who are pregnant, breast feeding, or planning to have a child.
  • Talk to your patients about what they can do to stay safe while at work.
  • Talk with each patient about how soon after the birth they plan to return to work and their plans for breast feeding.
  • Detailed guidance from the Centers for Disease Control and Prevention (CDC) provides information on pregnancy, breastfeeding, and lead exposure.
    • Consideration for removal of pregnant women from a workplace for exposure starts at BLLs of 5 µg/dL and higher.
    • CDC encourages U.S. mothers with blood lead levels of less than 40 µg/dL to breastfeed. Mothers with higher blood lead levels are encouraged to pump and discard their breast milk until their blood lead levels drop below 40 µg/dL.
  • The Occupational Safety and Health Administration (OSHA) Lead Standard states, "The physician may recommend special protective measures or medical removal for an employee who is pregnant or who is planning to conceive a child when, in the physician's judgment, continued exposure to lead at the current job would pose a significant risk."
  • Lead can affect a man's reproductive health and his ability to father a child. See Resources section below for more information.
Help your patients protect their family.
  • Lead dust can travel easily on workers' hair, skin, clothes, shoes, and tools.
  • Encourage your patients to shower before leaving work, not bring work clothes and other items home, and to wash work clothes in a separate laundry load from their family's clothes.
  • More information and fact sheets for your patients are in Resources below.

Testing for Lead and Management Guidelines

Source: Council of State and Territorial Epidemiologists (CSTE) Management Guidelines for Blood Lead Levels in Adults. CSTE Occupational Subcommittee, June 2013.

  • Blood lead level (BLL) monitoring should be done on a scheduled basis, based on an individual's risk of exposure to lead.
  • Primary management of lead poisoning is source identification and the elimination or reduction of further exposure.
  • A single BLL does not reflect cumulative body burden, nor predict long-term effects. Recent evidence suggests that chronic low-level lead exposure has adverse health effects in adults and no blood lead threshold level for these effects has been identified.
  • Treatment decisions, including chelation, should be made in consultation with a physician knowledgeable about lead poisoning medical management.
Blood Lead Level (µg/dL) Management Recommendations
<5 No action needed. Monitor BLL if ongoing exposure.
5-9

Discuss health risks. Minimize exposure. Monitor BLL.

Consider removal for pregnancy and certain medical conditions.

10-19

Decrease exposure. Remove from exposure for pregnancy. Monitor BLL.

Consider removal for certain medical conditions or BLL ≥ 10 for an extended period of time.

20-29

Remove from exposure for pregnancy.

Remove from exposure if repeat BLL in 4 weeks remains ≥ 20.

Annual lead medical exam recommended.

30-49

Remove from exposure. Prompt medical evaluation.

50-79

Remove from exposure. Prompt medical evaluation.

Consider chelation with significant symptoms.

≥ 80

Remove from exposure. Urgent medical evaluation.

Chelation may be indicated.

Note: The above management guidelines recommend removal from lead exposure at blood lead levels that are lower than those at which Medical Removal Protection is required under the current OSHA lead standards. However, OSHA job protections also apply whenever a licensed health care provider removes an individual from lead exposure, whatever the patient’s blood lead level, if the individual has a lead-related problem or has a medical condition that places the worker at greater risk from lead exposure. Because of the complexity in recommending medical removal below levels required by OSHA, a physician making such a recommendation may want to review the OSHA regulations, consult with a physician familiar with the regulatory process, and discuss with their patient how this may affect their employment. For further information on this topic, please see the medical removal protection provisions of the OSHA lead standards.

Source: Council of State and Territorial Epidemiologists (CSTE) Management Guidelines for Blood Lead Levels in Adults. CSTE Occupational Subcommittee, June 2013.

Blood Lead Reporting Requirements

  • All laboratories must report all blood lead levels to the Wisconsin Department of Health Services.
  • In the order to laboratory, health care providers are required by Wis. Admin. Code DHS 181 to send required demographic information that the lab is unlikely to have, including employer and occupation.
  • Employer and occupation information are reported by the laboratory in its Laboratory Results Report within the HL7 message (often NK1 - 13 fields).
  • More information on blood lead reporting requirements is on our page, For Laboratories and Researchers.

Resources

Wisconsin Resources
NIOSH/CDC/OSHA Resources
Other State Resources
Other Resources

Contact us about the Wisconsin Adult Lead Program
Email: dhsocchealth@dhs.wisconsin.gov
Phone: 608-266-1120

 

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Last Revised: September 30, 2020