Lead poisoning: when to measure blood lead and what to do with the result (child, pregnant woman)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Child with a risk factor for exposure: screening blood lead
Laboratory tests (fasting not required)
- Venous sample from the antecubital fossa, in a specific "metals" tube (anticoagulant, no gel), away from places of exposure.
- Blood lead (enclose the completed Cerfa form no. 12378 "surveillance des plombémies")
- FBC
- Serum ferritin
Also consider
- Newly arrived migrant child? See the page "Newly arrived migrant".
Do not order
Blood lead < 50 µg/L: no lead poisoning, but follow-up if the risk persists
Blood lead 25 to 49 µg/L (vigilance threshold): repeat in 3 to 6 months
- Blood lead (with Cerfa form no. 12378)
- Then every 6 to 12 months up to 6 years if blood lead remains ≥ 25 µg/L or if a risk factor persists.
Blood lead ≥ 50 µg/L: lead poisoning, notifiable in France
- Mandatory notification to the ARS (regional health agency, France): send the completed Cerfa form no. 12378 (clinical information and result), after informing the parents.
- Blood lead ≥ 250 µg/L: opinion from a specialised paediatric department within the month; ≥ 450 µg/L: refer urgently (chelation).
Blood lead 50 to 249 µg/L: repeat at 3 months, then every 3 to 6 months
- Blood lead (with Cerfa form no. 12378)
- 25-hydroxyvitamin Dif neededThe HCSP (French High Council for Public Health) guide says to look for vitamin D deficiency in the lead-poisoned child [2]; vitamin D increases the digestive absorption of lead: do not supplement while lead is still present in the digestive tract (pica) [2].
Pregnant woman or pregnancy planned within 6 months, exposed to lead
If at least one risk factor for exposure is identified
- Blood lead
If blood lead 50 to 249 µg/L: at least once a quarter during the first 6 months, then every month until delivery
- Blood lead
- At birth: blood lead in the mother and in the newborn (cord blood).
Sources (8)
- Repères pour votre pratique : Diagnostiquer et prévenir le saturnisme avant 18 ans. Document destiné aux professionnels de santé, état des connaissances décembre 2017 (hébergé par l'ARS PACA ; cite Saturn-inf 2008-2009).
- Haut Conseil de la santé publique. Mise à jour du guide pratique de dépistage et de prise en charge des expositions au plomb chez l'enfant mineur et la femme enceinte. Rapport final, octobre 2017 (validé le 19 octobre 2017).
- CHU de Lille, pôle de biologie-pathologie-génétique, unité de toxicologie. Préconisations préanalytiques : dosage des métaux et éléments traces (fiche PRA-FI-TOX-353, version 3, 11 août 2025).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0565 (plombémie) et 1139 (25-OH-vitamine D).
- Ruckart PZ, Jones RL, et al. Update of the Blood Lead Reference Value — United States, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(43):1509-1512.
- US Preventive Services Task Force. Inactive: Elevated Blood Lead Levels in Children and Pregnant Women: Screening (la recommandation de 2019 ne sera pas actualisée).
- UK Health Security Agency. Lead: clinical intervention. Dans : Lead poisoning: advice for the public and healthcare professionals, publié le 8 octobre 2024.
- World Health Organization. WHO guideline for the clinical management of exposure to lead. Genève : OMS, 2021.