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HEALTH ADVISORY: DSHS adopts new blood lead reference value of 3.5 ug/dL

Health Advisory
Health Advisory
February 15, 2023


As of January 1, 2023, the Texas Department of State Health Services (DSHS) uses a 3.5 ug/dL blood lead reference value (BLRV) to identify children who should receive medical and public health follow-up. DSHS encourages all health care providers to report all blood lead levels in children to DSHS as required and to follow the updated Reference for Blood Lead Retesting and Medical Case Management, Pb-109 form, which provides follow-up guidance for blood lead levels at 3.5 ug/dL and above.  


Lead exposure can have serious consequences for children's health. There is no known safe blood lead concentration; even blood lead levels as low as 3.5 ug/dL may be associated with decreased intelligence in children, behavioral difficulties, and learning problems. As lead exposure increases, the range and severity of symptoms and effects also increases.

BLRV is a screening tool to identify children who have higher blood levels compared to most children. The change will identify more children with lead exposure so that parents and doctors can take action early to mitigate the effects of lead. The change also aligns with national standards.

Texas law requires reporting of all blood lead tests (with any result) for children younger than 15 years of age. Physicians, laboratories, hospitals, clinics, and other healthcare facilities must report all blood lead tests to the DSHS Texas Childhood Lead Poisoning Prevention Program (TXCLPPP). In turn, TXCLPPP notifies providers and parents/guardians about children with blood lead levels of 3.5 ug/dL or greater. The program also conducts environmental lead investigations for those children who qualify.   


  • Healthcare providers should use the updated BLRV of 3.5 ug/dL, instead of the previous 5 ug/dL in case management and refer to the Reference for Blood Lead Retesting and Medical Case Management, Pb-109 form, which has been updated to reflect current guidance for appropriate follow-up actions.
  • Health care providers should refer to the Childhood Blood Lead Screening Guidelines, PB-120, for recommended blood lead testing for children, which includes testing of all Medicaid-enrolled children at ages 12 and 24 months, or at ages 24-72 months if not previously tested.
  • Health care providers should report all blood lead test results, including complete demographic, testing, and provider information, as required by law. Reporting can be done electronically or by fax.


Contact Information

For questions about this health advisory, please contact:

DSHS Blood Lead Surveillance Branch