Monitoring and follow up after chelation therapy

Monitor whole blood lead concentrations weekly during chelation therapy, and 10 to 14 days after stopping therapy to check for lead redistribution from bone. Whole blood lead concentration may rebound with this redistribution and necessitate a repeat course of chelation therapy—seek advice from a clinician experienced in treating lead poisoning or a clinical toxicologist if a rebound in whole lead blood concentration is seen. Serial whole blood lead concentrations can also help to confirm removal from the source of lead exposure.

All chelation therapies carry the risk of micronutrient deficiency, including iron, zinc and copper. Blood concentrations of these elements should be checked before and during chelation therapy, and any deficiencies corrected. In particular iron deficiency should be treated as quickly as possible, especially if there is ongoing exposure to lead, because iron deficiency may increase lead absorption.

Repeat the patient’s full blood examination (looking for neutropenia due to succimer) and liver biochemistry (looking for liver injury) after 5 days of chelation therapy.