Description

Lead poisoning may present as anaemia and it is important to consider this in patients where the cause of the anaemia is elusive. In our district general hospital we had two new patients whom were found to be anaemic with normal levels of iron, B12 and folate. After careful
questioning they were found to have to have been exposed to lead; in the first case in the form of herbal capsules and in the second in the form of lead based paints. The relevant Heam Synthetic Pathway tests and serum lead levels confirmed the presence of lead poisoning in both cases and also lead to the discovery of a related case for each index case. It is important remember that lead has a very long half life in bones and that long term chronic exposure may require chronic chelation therapy in order to ensure adequate removal of lead. The serum lead levels correlate well with the degree of toxicity in the acute situation but are less useful in the chronic scenario. We recommend more use of the pyrimidine 5’nucleotidase level which is highly sensitive even at lowest levels of lead exposure thought to be significant in children. Finally the use of the EDTA provocation test is of limited diagnostic value unless it is used specifically to look for subclinical toxicity in order to decide if the patient would benefit from chelation therapy.