Lead poisoning

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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 47-year-old man is brought to the office by his son due to increased forgetfulness and fatigue for the past three months. He has also been frequently stumbling and experienced several near-falls while climbing stairs. Review of systems is also notable for abdominal pain and numbness in the patient’s hands and feet. Past medical history is unremarkable, and he does not take any medications. He has been working as an automobile mechanic for the last 20 years. Vitals are within normal limits. The abdomen is soft, nontender, and without organomegaly on physical examination. Neurological examination reveals weakness and reduced pinprick sensation in the bilateral hands and feet. Upper and lower limb reflexes are 2/5. Laboratory testing is shown below. Which of the following is the most likely diagnosis?

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