What is the role of iron tests in the workup of lead toxicity?

Updated: Jan 16, 2020
  • Author: Pranay Kathuria, MD, FACP, FASN, FNKF; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Lead toxicity causes a hypochromic microcytic anemia and basophilic stippling of red blood cells. Hypochromia and microcytosis are typically seen in iron-deficiency anemia, which often coexists with lead toxicity. Assessing iron storage status (ferritin) in all cases of lead poisoning is important. In pregnant women, some evidence suggests that lead also causes a decrease in erythropoietin production and a depression in red blood cell (RBC) production. Lead is a surface-acting poison and may produce increased RBC fragility and acute hemolytic anemia (see the image below).

Peripheral smear taken from 8-year-old Pakistani g Peripheral smear taken from 8-year-old Pakistani girl who presented with acute hemolytic anemia and lead level of 125 µg/dL.

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