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Blood lead testing: who to test, when, and how to respond to the result

By Elizabeth O’Brien, Global Lead Advice and Support Service (GLASS), August 2009

Who should have a blood lead test and when?

All children under the age of 6 years should have a blood lead test at least annually, starting from the age of crawling, and more frequently if the blood lead level exceeds 2 micrograms per decilitre (µg/dL), if they live in a house built before 1997 or if they suffer from pica (eating non-food items) or iron deficiency anaemia.

All children with learning difficulties, autism, ADD, ADHD or aggressive behaviour should be blood lead tested.

For everyone born before leaded petrol was banned in Australia in 2002, after the age of 6, a blood lead test should be done every 5 years throughout life, or more frequently if the blood lead level exceeds 2 µg/dL.

Anyone planning to move into and especially if you’re planning to renovate a pre-1997 building in Australia should have a blood lead test prior to beginning the work and again within a couple of weeks of starting the work (especially preparation of paint for repainting or any demolition) to determine that their renovation methods are indeed lead-safe. If the family must remain in a home during renovation, all family members should be tested.

If your neighbour or your landlord starts demolishing or drysanding or waterblasting paint off their old building or your’s, take everyone to the doctor for a blood lead test – get a copy of the results in case it ends up in a tribunal hearing.

People who work with lead or are involved in hobbies (leadlighting, ceramics, jewellery-making, fishing-sinker or diving weight or bullet-making, artist’s painting, etc) which use lead, should have blood lead testing, prior to beginning the work or hobby, then a couple of weeks into it, and as often as dictated by the result and changes made to work-practices to reduce the blood lead level, but at least annually to ensure that the blood lead level never goes above 2 µg/dL. If it does, consider switching to other non-lead work or hobbies.

Shooters should particularly be required to have blood lead tests before they ever take up a gun (or apply for a licence) and shortly after beginning their training, especially if they practice at an indoor firing range. Regular blood lead monitoring will let your doctor know whether you have the genotype or shooting frequency that dictate that you really are not safe to use a gun.

Anyone who has a lodged lead shot or bullet in them should have a blood lead test every 6 months or more frequently if the blood lead level rises above 2 µg/dL. This can occur especially if the lodged lead object or fragment moves into the synovial fluid of a joint. Your doctors should be made aware that you have been shot and have retained the leaded ammunition, so that they can better monitor not only your blood lead level but also your nutritional status and regularly weigh the risks of surgical removal of the lead pellets against the risks of lead poisoning.

Couples planning to conceive should aim to have a blood lead level as low as possible but certainly below 5 µg/dL and for the father, this level should be achieved before the sperm are manufactured (ie at least three months before conception).

People who are about to move to a known high-lead-risk area such as the communities surrounding lead mining, smelting, manufacturing or recycling facilities, should test everyone in their family, and themselves especially if they are about to start work at the lead facility.

Due to the synergistic effects of lead and mercury, anyone in the above categories who also has mercury amalgam fillings should have a blood lead test every couple of years throughout life and consider having their mercury amalgam fillings replaced if their blood lead level is above 2 µg/dL.

Because blood lead levels above 2 µg/dL have been found to have adverse effects on the developing brain in the foetus and in early childhood, we recommend that women in early pregnancy and again at the birth have a blood lead test. Pregnancies will generally raise the blood lead level (some pregnancies more than others). The early blood lead level and final umbilical cord blood lead level are good baseline levels to know for the baby. (Organise in advance for the test to be carried out at the birth.) The placenta does not filter lead out so these results can be considered to be the baby's first blood lead tests. The peak blood lead level for a pregnancy (typically reached at the birth) will depend on a woman’s lifetime exposure to lead so is a very important figure to obtain.

Anyone who has a high hair lead test result should have a blood lead test to determine if there is a problem and to have a result (the blood lead result) which will be followed up by the health department.

A blood lead test result can demonstrate that despite no obvious sources or pathways of current lead poisoning, lead is indeed currently being taken up. Additionally, a blood lead test can demonstrate that stored lead is moving from the bones back into the bloodstream. The movement of lead out of the bone stores and back into the bloodstream is a complex business and not all the provocations for that movement are fully understood.

Seventy-five percent of a child’s body burden of lead and 95% of an adult’s body burden of lead is stored in the bones. For this reason, in the absence of historical blood lead results, the best way to assess long-ago lead poisoning is with a bone XRF machine. Unfortunately no bone XRF machine is currently operational in Australia.

Testing for lead in the blood answers the critical question: is lead moving out of the bones or coming in from the environment, and being circulated to all organs and tissues, via the blood? The type of change that can move lead out of bone storage, includes, but may not be limited to: treatments for lead poisoning (eg saunas, chelation therapy etc including mega doses of Vitamin C, which is known as "the natural chelator"), some drug treatments for other conditions (eg cortisone), bone breaks, drastic changes in exercise level (eg suddenly training for a marathon without previous running experience, or suddenly being immobilised in hospital for a period), the bone demineralisation associated with pregnancy, lactation, menopause and ageing, and possibly excess sun exposure.

Women being treated with Hormone Replacement Therapy (HRT) and anyone on cortisone should have a blood lead test every 6 months to determine whether the treatment or the medical problem is associated with a rise in the blood lead level.

Anyone suffering any of the health effects or behaviour problems mentioned in "Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to both adults and children"  and in “Lead, Ageing and Death” should also ask their GP or specialist for a blood lead test.

Various individual and government responses to blood lead levels

For the individual who knows the dangers of a blood lead level above 2 µg/dL, the critical steps in responding to a blood lead level above 2 µg/dL are to identify the sources of lead and remove them (or remove the person from the lead), as well as to implement nutritional intervention. A well-informed doctor can assist greatly in these two vital responses.

Government health agencies should be able to help in the lead source identification process (home lead assessment etc), but, should it be necessary, you can find details of The LEAD Group's excellent DIY-sampling for lab lead testing (in Australia) kits

“Acceptable” blood lead levels

The National Health and Medical Research Council has issued a statement on 6th August 2009 that the goal is that all Australians should have a blood lead level below 10 micrograms per 100 millilitres of blood (10 µg/dL). This is the level recommended by the US Centers for Disease Control and Prevention in 1991 and the World Health Organisation in 1992. It is also the level which the NHMRC itself recommended in 1993.

The LEAD Group believes that the “acceptable” blood lead level should be two micrograms per decilitre (100 millilitres), based on research referred to below. By “acceptable” we mean a level below which the harmful effects of lead are acceptable considering what a huge boost to the Australian economy lead mining, smelting and export affords us. As a “goal”, that is, a level which all Australians should be below, we propose 5 micrograms per 100 millilitres of blood (5 µg/dL). As a marker on the way to achieving this, we proposed below 10 µg/dL as a “target” level for all Australians – to be reached by 2012. We do not find it acceptable that the current occupational level for moving a worker from a lead task is 50 µg/dL. Workers are people too and a little bit of extra pay doesn’t make up for early death, especially if you are not advised that that is the risk you are taking.

“Notifiable” blood lead levels

In NSW, Queensland or Tasmania, if a non-occupationally exposed person’s blood lead level is found by a pathology laboratory to be 15 micrograms per decilitre (15 µg/dL) or over, the lab must notify the state department of health. A home lead assessment would normally then be carried out by the local Public Health Unit.

In other states and territories there is no requirement in public health regulations to notify the health department if your blood lead level is above 15 µg/dL. We therefore advise you or your GP or obstetrician to request the relevant state department to do a home lead assessment. This is done by phoning:

  • Environmental Health Unit, Department of Human Services, Victoria on 1300761874;

  • Department of Health, South Australia on 0882266000;

  • Health Department, Western Australia on 0893884999;

  • ACT (Australian Capital Territory) Health Protection Service on 0262051700;

  • Northern Territory Environmental Health Department, Territory Health Services on 0889227152.

Actions recommended by government departments at blood lead levels less than 15 µg/dL

The Western Australian Health Department is now following up blood lead levels above 5 micrograms per decilitre in Esperance, Western Australia and the Queensland Health Department is following up blood lead levels above 10 micrograms per decilitre in Mount Isa lead mining & smelter town.

If anyone in your family has a blood lead level below 15 micrograms per decilitre but above 2 micrograms per decilitre, then you would be wise to do some testing in your home or otherwise think about any potential lead exposure in work or hobbies, in order to identify and then eliminate any lead sources. You could also try phoning your state health department to ask them to carry out a home lead assessment in view of policies elsewhere.

See above list and additionally:

  • Department of Health, New South Wales on 0293919000;

  • Queensland Health on 0732340111;

  • Department of Health and Human Services (DHHS) Tasmania on 1300135513.

In the United Kingdom, doctors are advised to carry out blood lead testing on children diagnosed with learning difficulties and autism.

All state and local health departments in the United States were, on 7th August 2009, recommended to increase the rate of blood lead screening of at-risk children under 6 years of age, in just one of many strategies to achieve the US national Healthy People target, set in 2000, that no child between the ages of 1 to 6 years in the US should have a blood lead level higher than 10 µg/dL by 2010.

In some government agencies in the United States, the follow-up (search for sources) blood lead level has been set at 5 µg/dL. For instance "Understanding Your Child’s Lead Test" by the Oregon Department of Human Services (DHS), states: “parents should take steps to identify possible sources of lead in their child’s environment in order to prevent any further exposure” [if the blood lead level is 5 µg/dL or higher].

The Forsyth County (North Carolina - Winston-Salem area) Board of Health approved, in November 2008, regulations requiring environmental investigations for children with a blood lead level of 8 µg/dL or higher and allows parents with children with a level of 5 µg/dL or higher to request inspections.

The views expressed herein are not necessarily the views of the Australian Government, and the Australian Government does not accept responsibility for any information or advice contained herein.

PDF version of this file

The LEAD Group Inc. Fact Sheet Index

NSW Lead Reference Centre and NSW Government Publications On this site

  1. About the Global Lead Advice and Support Service (GLASS)

  2. Main Sources of Lead

  3. How Would You Know If You or Your Child Was lead poisoned?

  4. Lead aware housekeeping

  5. Ceiling dust & lead poisoning

  6. Is your yard lead safe?

  7. Health Impacts of lead poisoning

  8. Rotary Questionnaire

  9. Lead poisoned Pets and Your Family

  10. Childhood Lead Poisoning Risk Factor Questionnaire

  11. Is Your Child Safe From Lead? - What Can You Do About Lead?

  12. Lead in Drinking Water in Australia

  13. Have We Really Resolved The Lead Issue?

  14. The Importance of the Availability of "Spot Tests" for Lead in Paint

  15. Pregnant or Planning a Pregnancy

  16. Breastfeeding and Lead

  17. Lead in breast milk

  18. Beware The Lead In Lead Lighting

  19. Renting and Lead

  20. What to do if you have too much lead in your tank water

  21. Lead Contamination in Stormwater

  22. Contamination At Shooting Ranges

  23. Banned: Leaded Wick Candles

  24. Lead, Ageing and Death

  25. Metal miniatures: How to minimise the risks of lead poisoning and contamination

  26. 7 Point Plan for the MANAGEMENT OF LEAD by Australian parents and carers

  27. Countries where Leaded Petrol is Possibly Still Sold for Road Use, As at 17th June 2011

  28. Lead Poisoning And The Brain - Cognitive Deficits And Mental Illness

  29. Facts and Firsts of Lead

  30. Lead mining royalties by state and territory

  31. Lead Mining Stewardship - Grey Lead and the Role of The LEAD Group

  32. Preventative Strategies of The LEAD Group

  33. What do Doctors need to do about Lead?

  34. A Naturopath's Experience Of Lead & People With Diagnosed Mental Illness

  35. Case File: Helping Manage Australian Lead in Petrol - How GLASS Works

  36. Glass Web & Service-Users, Experts & Volunteers, by Country; Countries with Leaded Petrol for Road Use & Worst Pollution

  37. Lead in ceiling dust

  38. Lead paint & ceiling dust management - how to do it lead-safely

  39. Esperance parliamentary inquiry follow-up factsheet: Where to from Here??

  40. Broken Hill lead miners factsheet 1893 with Note 20081015

  41. Helping a Doctor Help 35,000 Lead-Poisoned People Around the Lead Smelter at La Oroya in Peru
    Ayuda a un doctor que ayuda 35,000 personas envenenadas por plomo alrededor de la fundidora de plomo en la Oroya-Peru

  42. Fact sheet for Australian toy importers and traders

  43. Iron Nutrition & Lead Toxicity
    Informe de Acciones – Hierro y Plomo en la Nutrición

  44. Sanitarium-Are You getting Enough Iron

  45. Do-It-Yourself-Lead-Safe-Test-Kits-flyer

  46. Blood lead testing: who to test, when, and how to respond to the result

  47. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to both adults and children

  48. Lead Exposure & Alzheimer’s Disease: Is There A Link?

  49. In CHINA - Blood lead testing: who to test, when, and how to respond to the result

  50. Why you should have your ceiling dust removed before you take advantage of the Australian government's Energy Efficient Homes Package: Insulation Program

  51. Alperstein et al Lead Alert - A Guide For Health Professionals 1994

  52. Ceiling Dust WorkCover Guide Lee Schreiber Final Nov 1999

  53. What can I do about climate change AND lead?

  54. The Need for Expert Clinical Assessments in Diagnosis Of Heavy Metal Poisoning

  55. Why you should have your ceiling dust removed before you have insulation installed

  56. Thirty Thought-Starters on Ceiling Void Dust in Homes

  57. Pectin: Panacea for both lead poisoning and lead contamination

  58. Nutrients that reduce lead poisoning June 2010

  59. Lead poisoning and menopause

  60. Fact sheet For Schoolkids From Professor Knowlead About Lead

  61. Prevention of Exposure to Lead at Work in Indonesia

  62. Mencegah kontak dengan timbal di tempat kerja di Indonesia

  63. How to Protect Your Family from Lead in Indonesia

  64. Bagaimana melindungi keluargamu dari timbal di Indonesia

  65. Cigarette Smoking & Lead Toxicity
     صحيفة معلومات: التدخين والتسمم بالرصاص

  66. Medical Evaluation Questionnaire For Occupational Lead Exposure

  67. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to children

  68. Dangers of a blood lead level above 2 µg/dL and below 10 µg/dL to adults

  69. Biosolids used as fertilizer in China and other countries

  70. What are the lead poisoning risks of a lead pellet, bullet or shot lodged in the body?

  71. Alcohol’s link to higher lead and iron levels

  72. USA Case Definition of Adult (including Occupational) & Child Elevated Blood Lead Levels (EBLL)

  73. Low Level Lead Exposure Harms Children - A Renewed Call for Primary Prevention

  74. Occupational Health & Safety Fact Sheet Dangers of lead for roofers

  75. Let’s Make Leaded Petrol History - Let’s Make Leaded Gasoline History

  76. Lead, Your Health & the Environment. Available in Arabic, Chinese, English, Korean, Macedonian, Spanish, Turkish and Vietnamese 

  77. Lead Safe Housekeeping

  78. Old Lead Paint

  79. Working safely with lead

  80. A Renovator's Guide To The Dangers Of Lead (Brochure 30 pages)

  81. A Guide For Health Care Professionals (Brochure 34 pages)

  82. A Guide To Keeping Your Family Safe From Lead (Brochure 20 pages)

  83. Lead Hazard Management In Children's Services (Brochure 15 pages)

  84. A Guide To Dealing With Soil That Might Be Lead-Contaminated

  85. Exposure Assessment: Lead Neurotoxicity - Is the Center for Disease Control's goal to reduce lead below 10 µg/dl blood in all children younger than 72 months by 2010, good enough?

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