Abstract
The clinical, biochemical, and haematological aspects of a recent outbreak of lead poisoning, in which exposure was related to the oxyacetylene cutting of red lead painted ironwork, were investigated. Initial suspicion was raised when a blood film showed punctate basophilia which remains a simple and useful method of picking up lead toxicity. Estimations of blood lead concentration and conventional laboratory data confirmed the diagnosis. Although there was prominent punctate basophilia, spectrophotometric analysis showed only negligible accumulation of pyrimidine-5'-nucleotides despite severe suppression of pyrimidine-5'-nucleotidase activity. The pattern of the red cell glycolytic intermediates, investigated for the first time, suggested that lead may also affect glycolysis at the hexokinase step. Once the diagnosis was made intravenous chelation treatment was begun with a rapid improvement in symptoms. Long term follow up is required to assess any sequelae of intoxication. These cases emphasise the classic features of lead poisoning, and despite the currently available diagnostic tests, lead intoxication may still go unrecognised unless a thorough occupational history is taken.
Full text
PDF




Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Albahary C. Lead and hemopoiesis. The mechanism and consequences of the erythropathy of occupational lead poisoning. Am J Med. 1972 Mar;52(3):367–378. doi: 10.1016/0002-9343(72)90025-3. [DOI] [PubMed] [Google Scholar]
- Aposhian H. V. DMSA and DMPS--water soluble antidotes for heavy metal poisoning. Annu Rev Pharmacol Toxicol. 1983;23:193–215. doi: 10.1146/annurev.pa.23.040183.001205. [DOI] [PubMed] [Google Scholar]
- Braithwaite R. A., Brown S. S. Clinical and sub-clinical lead poisoning: a laboratory perspective. Hum Toxicol. 1988 Sep;7(5):503–513. doi: 10.1177/096032718800700518. [DOI] [PubMed] [Google Scholar]
- Crowne H., Lim C. K., Samson D. Determination of 5-aminolaevulinic acid dehydrase activity in erythrocytes by high-performance liquid chromatography. J Chromatogr. 1981 May 8;223(2):421–425. doi: 10.1016/s0378-4347(00)80116-4. [DOI] [PubMed] [Google Scholar]
- Cullen M. R., Robins J. M., Eskenazi B. Adult inorganic lead intoxication: presentation of 31 new cases and a review of recent advances in the literature. Medicine (Baltimore) 1983 Jul;62(4):221–247. [PubMed] [Google Scholar]
- Goldberg A. Lead poisoning and haem biosynthesis. Br J Haematol. 1972 Nov;23(5):521–524. doi: 10.1111/j.1365-2141.1972.tb07087.x. [DOI] [PubMed] [Google Scholar]
- Grandjean P., Lintrup J. Erythrocyte-Zn-protoporphyrin as an indicator of lead exposure. Scand J Clin Lab Invest. 1978 Nov;38(7):669–675. doi: 10.3109/00365517809102434. [DOI] [PubMed] [Google Scholar]
- Hansen J. P., Døssing M., Paulev P. E. Chelatable lead body burden (by calcium-disodium EDTA) and blood lead concentration in man. J Occup Med. 1981 Jan;23(1):39–43. doi: 10.1097/00043764-198101000-00017. [DOI] [PubMed] [Google Scholar]
- Keogh J. P. Recognizing lead poisoning in adults. Arch Intern Med. 1984 Oct;144(10):1944–1945. [PubMed] [Google Scholar]
- Lestas A. N., Kay L. A., Bellingham A. J. Red cell 3-phosphoglycerate level as a diagnostic aid in pyruvate kinase deficiency. Br J Haematol. 1987 Dec;67(4):485–488. doi: 10.1111/j.1365-2141.1987.tb06173.x. [DOI] [PubMed] [Google Scholar]
- Lestas A. N., Nicolaides K. H., Rodeck C. H., Bellingham A. J. Normal levels of ATP, total nucleotides and activities of three enzymes related to nucleotide metabolism in fetal erythrocytes. Br J Haematol. 1986 Jul;63(3):471–476. doi: 10.1111/j.1365-2141.1986.tb07523.x. [DOI] [PubMed] [Google Scholar]
- Lim C. K., Rideout J. M., Wright D. J. Separation of porphyrin isomers by high-performance liquid chromatography. Biochem J. 1983 May 1;211(2):435–438. doi: 10.1042/bj2110435. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lolin Y., O'Gorman P. An intra-erythrocytic low molecular weight lead-binding protein in acute and chronic lead exposure and its possible protective role in lead toxicity. Ann Clin Biochem. 1988 Nov;25(Pt 6):688–697. doi: 10.1177/000456328802500616. [DOI] [PubMed] [Google Scholar]
- Malcolm D., Barnett H. A. A mortality study of lead workers 1925-76. Br J Ind Med. 1982 Nov;39(4):404–410. doi: 10.1136/oem.39.4.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moore M. R., Beattie A. D., Thompson G. G., Goldberg A. Depression of delta-aminolaevulic acid dehydrase activity by ethanol in man and rat. Clin Sci. 1971 Jan;40(1):81–88. doi: 10.1042/cs0400081. [DOI] [PubMed] [Google Scholar]
- Paglia D. E., Valentine W. N. Characteristics of a pyrimidine-specific 5'-nucleotidase in human erythrocytes. J Biol Chem. 1975 Oct 25;250(20):7973–7979. [PubMed] [Google Scholar]
- Paglia D. E., Valentine W. N., Dahlgren J. G. Effects of low-level lead exposure on pyrimidine 5'-nucleotidase and other erythrocyte enzymes. Possible role of pyrimidine 5'-nucleotidase in the pathogenesis of lead-induced anemia. J Clin Invest. 1975 Nov;56(5):1164–1169. doi: 10.1172/JCI108192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pasanen A. V., Vuopio P., Borgström G. H., Tenhunen R. Haem biosynthesis in refractory sideroblastic anaemia associated with the preleukaemic syndrome. Scand J Haematol. 1981 Jul;27(1):35–44. doi: 10.1111/j.1600-0609.1981.tb00449.x. [DOI] [PubMed] [Google Scholar]
- Piddington S. K., White J. M. The effect of lead on total globin and alpha- and beta-chain synthesis; in vitro and in vivo. Br J Haematol. 1974 Jul;27(3):415–427. doi: 10.1111/j.1365-2141.1974.tb06808.x. [DOI] [PubMed] [Google Scholar]
- Segel G. B., Feig S. A., Baehner R. L., Nathan D. G. Fluorometric analysis of glycolytic intermediates and pyridine nucleotides in peripheral blood cells. J Lab Clin Med. 1971 Dec;78(6):969–976. [PubMed] [Google Scholar]
- Valentine W. N., Fink K., Paglia D. E., Harris S. R., Adams W. S. Hereditary hemolytic anemia with human erythrocyte pyrimidine 5'-nucleotidase deficiency. J Clin Invest. 1974 Oct;54(4):866–879. doi: 10.1172/JCI107826. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Valentine W. N., Paglia D. E., Fink K., Madokoro G. Lead poisoning: association with hemolytic anemia, basophilic stippling, erythrocyte pyrimidine 5'-nucleotidase deficiency, and intraerythrocytic accumulation of pyrimidines. J Clin Invest. 1976 Oct;58(4):926–932. doi: 10.1172/JCI108545. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Waldron H. A. Lead poisoning in the ancient world. Med Hist. 1973 Oct;17(4):391–399. doi: 10.1017/s0025727300019013. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Waldron H. A. The anaemia of lead poisoning: a review. Br J Ind Med. 1966 Apr;23(2):83–100. doi: 10.1136/oem.23.2.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
- White J. M., Selhi H. S. Lead and the red cell. Br J Haematol. 1975 Jun;30(2):133–138. doi: 10.1111/j.1365-2141.1975.tb00526.x. [DOI] [PubMed] [Google Scholar]


