Anemia associated with lead

Anemia associated with lead

Updated: 07/24/2024

© Jun Wang, MD, PhD

 

General features

  • Children <6 years especially vulnerable
  • May severely affect mental and physical development

Pathogenesis

  • Inhibits enzymes involved in heme synthesis

o   Ferrochelatase

§  Incorporation of iron into protoporphyrin

§  Elevated free erythrocyte chelates with zinc

  • δ-aminolevulinate dehydratase
  • Coproporphyrin oxidase

Clinical features

  • In children

o   Developmental delay, learning difficulties, irritability, loss of appetite, weight loss, sluggishness and fatigue, abdominal pain, vomiting, constipation, hearing loss, seizures, pica (eating things that aren't food, like paint chips or dirt)

o   Bluish discoloration along gum (lead line), rare, suggestive of severe and prolonged lead exposure

o   Prenatal expose associated with premature birth and lower birth weight

  • In adults

o   High blood pressure

o   Difficulties with memory or concentration

o   Mood disorders

o   Headache, abdominal pain, joint and muscle pain

o   Reduced sperm count and abnormal sperm

o   Miscarriage/stillbirth or premature birth

Laboratory findings

o   Inhibition of pyrimidine 5’nucleotidase which normally breaks down RNA in RBCs

o   Denatured RNA forms basophilic stippling

  • Mild hemolysis Marrow findings
  • Elevated blood lead levels

 

 

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Contents

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Anemia

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