A JH
MORPHOLOGY UPDATE
AJH Educational Material
Lead Poisoning Barbara J Bain*
.
A 50-year-old Indian woman newly arrived in the United Kingdom from India had a nine month history of anorexia, nausea, constipation and dyspnea. Her full blood count showed: white cell count 9 3 109/l, hemoglobin concentration 83 g/l, mean cell volume 85 fl, platelet count 249 3 109/l and reticulocyte count 281 3 109/l. Her blood film showed prominent basophilic stippling (left), involving even the occasional circulating nucleated red blood cell (right). Mild poikilocytosis and some polychromatic macrocytes were also noted. Examination of the patient showed a lead line on her gums and serum lead was 82 lg/100 ml. The source of lead in this patient was not discovered but she recovered on moving to England. Acknowledged sources of lead are Indian cosmetics and ayurvedic medicines, not only those available in India but also those manufactured in the USA and sold via the internet [1]. Hematological effects of lead poisoning include a hypochromic microcytic anemia with sideroblastic erythropoiesis, a hemolytic anemia and a leucoerythroblastic blood film. The cause of the well known basophilic stippling and the hemolysis is inhibition of pyrimidine 50 nucleotidase while the hypochromic microcytic anemia and sideroblastic erythropoiesis are due to inhibition of enzymes involved in heme synthesis. Although lead poisoning is uncommon in most developed countries, haematologists should be alert to the possibility that alternative medications and food supplements containing lead may have been purchased during travel or via the internet. Other causes of lead poisoning include occupational exposure (battery production, foundry work, painting and construction, mining), retained bullets, and exposure to lead-based paints in older, poorly maintained houses (sometimes through pica) [2,3]. In developing countries sources of lead are much more widespread than in Western countries and include, in addition to traditional medicines, cosmetics and tooth-cleaning powders, the ongoing use of lead-based paints, water contamination from lead pipes and cisterns, use of lead-containing cookware and lead-glazed crockery, and unsafe practices in small factories and mines [3,4].
䊏 References
1. Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, Thuppil V, Kales SN. Lead, mercury, and arsenic in US- and Indianmanufactured ayurvedic medicines sold via the Internet. JAMA 2008;300:915–3. 2. Centres for Disease Control and Prevention. Very high blood lead levels among adults - United
States, 2002–2011. MMWR Morb Mortal Wkly Rep 2013;62:967–71. 3. Hore P, Ahmed M, Nagin D, Clark N. Intervention model for contaminated consumer products: a multifaceted tool for protecting public health. Am J Public Health 2014;104:1377–83. 4. Pfadenhauer LM, Burns J, Rohwer A, Rehfuess ES. A protocol for a systematic review of the
effectiveness of interventions to reduce exposure to lead through consumer products and drinking water. Syst Rev 2014;3:36. doi: 10.1186/2046– 4053-3–36.
Department of Haematology, St Mary’s Hospital Campus of Imperial College Faculty of Medicine, St Mary’s Hospital, Praed Street, London, N1 1NY, UK
*Correspondence to: Barbara J. Bain, [email protected] Received for publication: 10 September 2014; Accepted: 10 September 2014 Am. J. Hematol. 89:1141, 2014. Published online: 13 September 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ajh.23852 C 2014 Wiley Periodicals, Inc. V
doi:10.1002/ajh.23852
American Journal of Hematology, Vol. 89, No. 12, December 2014
1141
MORPHOLOGY UPDATE
AJH Educational Material
Lead Poisoning Barbara J Bain*
.
A 50-year-old Indian woman newly arrived in the United Kingdom from India had a nine month history of anorexia, nausea, constipation and dyspnea. Her full blood count showed: white cell count 9 3 109/l, hemoglobin concentration 83 g/l, mean cell volume 85 fl, platelet count 249 3 109/l and reticulocyte count 281 3 109/l. Her blood film showed prominent basophilic stippling (left), involving even the occasional circulating nucleated red blood cell (right). Mild poikilocytosis and some polychromatic macrocytes were also noted. Examination of the patient showed a lead line on her gums and serum lead was 82 lg/100 ml. The source of lead in this patient was not discovered but she recovered on moving to England. Acknowledged sources of lead are Indian cosmetics and ayurvedic medicines, not only those available in India but also those manufactured in the USA and sold via the internet [1]. Hematological effects of lead poisoning include a hypochromic microcytic anemia with sideroblastic erythropoiesis, a hemolytic anemia and a leucoerythroblastic blood film. The cause of the well known basophilic stippling and the hemolysis is inhibition of pyrimidine 50 nucleotidase while the hypochromic microcytic anemia and sideroblastic erythropoiesis are due to inhibition of enzymes involved in heme synthesis. Although lead poisoning is uncommon in most developed countries, haematologists should be alert to the possibility that alternative medications and food supplements containing lead may have been purchased during travel or via the internet. Other causes of lead poisoning include occupational exposure (battery production, foundry work, painting and construction, mining), retained bullets, and exposure to lead-based paints in older, poorly maintained houses (sometimes through pica) [2,3]. In developing countries sources of lead are much more widespread than in Western countries and include, in addition to traditional medicines, cosmetics and tooth-cleaning powders, the ongoing use of lead-based paints, water contamination from lead pipes and cisterns, use of lead-containing cookware and lead-glazed crockery, and unsafe practices in small factories and mines [3,4].
䊏 References
1. Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, Thuppil V, Kales SN. Lead, mercury, and arsenic in US- and Indianmanufactured ayurvedic medicines sold via the Internet. JAMA 2008;300:915–3. 2. Centres for Disease Control and Prevention. Very high blood lead levels among adults - United
States, 2002–2011. MMWR Morb Mortal Wkly Rep 2013;62:967–71. 3. Hore P, Ahmed M, Nagin D, Clark N. Intervention model for contaminated consumer products: a multifaceted tool for protecting public health. Am J Public Health 2014;104:1377–83. 4. Pfadenhauer LM, Burns J, Rohwer A, Rehfuess ES. A protocol for a systematic review of the
effectiveness of interventions to reduce exposure to lead through consumer products and drinking water. Syst Rev 2014;3:36. doi: 10.1186/2046– 4053-3–36.
Department of Haematology, St Mary’s Hospital Campus of Imperial College Faculty of Medicine, St Mary’s Hospital, Praed Street, London, N1 1NY, UK
*Correspondence to: Barbara J. Bain, [email protected] Received for publication: 10 September 2014; Accepted: 10 September 2014 Am. J. Hematol. 89:1141, 2014. Published online: 13 September 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ajh.23852 C 2014 Wiley Periodicals, Inc. V
doi:10.1002/ajh.23852
American Journal of Hematology, Vol. 89, No. 12, December 2014
1141
