Lead poisoning

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Summary of Lead poisoning

Lead poisoning interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive and nervous systems. Lead poisoning can also cause anemia. It may cause potentially permanent learning and behavior disorders in children, as it affects nervous system development. Symptoms include abdominal pain, confusion, headache, anemia, irritability, and in severe cases seizures, coma, and death. Classic case scenarios of lead poisoning involve children inside an old house with paint chips.

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Lead poisoning

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Chapter 52 Microcytic Anemias ▫ Blood smear analysis: erythrocytes with increased central pallor (> ⅓ diameter, anisocytosis (anisto = unequal), poikilocytosis (poikilo = irregular), target cells (resemble target; center stain with pallor ring, outside stain ring) ▪ Iron studies ▫ Decreased serum iron, ferritin (stores cellular iron) ▫ Decreased transferrin saturation (major iron transport protein) ▫ Increased total iron binding capacity OTHER DIAGNOSTICS ▪ History, physical examination (e.g. colonoscopy for GI bleed) TREATMENT MEDICATIONS ▪ PO iron supplements (e.g. ferrous sulfate) ▪ Parenteral iron ▫ Severe, persistent anemia ▫ Intolerance of PO iron ▫ Nonadherence to PO supplements/ dietary changes OTHER INTERVENTIONS ▪ Increase dietary iron ▫ Heme iron (e.g. meat) absorbed better than non-heme iron (e.g. eggs, legumes, nuts) ▫ Vitamin C increases absorption; calcium decreases absorption ▪ Blood transfusion LEAD POISONING-RELATED ANEMIA osms.it/lead-poisoning PATHOLOGY & CAUSES ▪ Lead exposure, toxicity → anemia ▪ Lead absorbed through lungs/skin/GI tract ▫ Interferes with enzymatic steps in heme pathway → decreased hemoglobin synthesis, microcytosis ▫ Impairs sodium/potassium ATPase in erythrocyte cell membrane → hemolysis RISK FACTORS ▪ Water contaminated with industrial waste/ from pipes made of lead/that contain lead solder ▪ Exposure to leaded paint/paint dust/chips (esp. children); increased risk in older homes (built before 1978, lead in paint since banned) ▪ Exposure to soil/dust contaminated with lead ▪ Breathing industrial emissions containing lead (e.g. smelters, reﬁneries, battery manufacturing, recycling) ▪ Food/ beverages from lead-glazed ceramics SIGNS & SYMPTOMS ▪ Small, hypochromic red blood cells → hypoxemia → decreased oxygen to tissues → tissue hypoxia → fatigue, dyspnea, activity intolerance ▪ Lead toxicity ▫ Abdominal pain, headache, difﬁculty concentrating, muscle/joint pain, confusion, ataxia OSMOSIS.ORG 417

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Lead poisoning

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A 2-year-old boy is brought to the pediatrician for a check up. The boy's mother states that he has been rather lethargic and weak for the past few months. Recently, his eyes have been tinged with yellow, and he has a mild fever. The patient has not traveled recently or had any sick contacts. His parents are vegetarian and so he eats mostly homegrown fruits and vegetables. On physical examination the patient appears underdeveloped for his age, pale, and confused. A peripheral blood smear shows schistocytes and basophilic stippling. Which of the following biochemical processes is the most likely cause of the patient's condition?

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