Lead poisoning - know the symptoms

01 March 2024

In the early 1990’s Australia banned the use of lead in items that humans can be exposed to, such as paints, pipes and petrol. But some medications purchased overseas can contain high lead levels, leading to lead toxicity or poisoning.

Lead is a heavy metal that even in low levels of exposure can cause symptoms of toxicity. Lead toxicity or poisoning causes a variety of symptoms dependent on the absorption and exposure levels.

Common effects include haematopoietic (the formation of blood cells), nervous (brain, spinal cord, nerves, etc), renal (kidneys), cardiovascular (heart and blood vessels), and reproductive symptoms. It can also cause anaemia.

Common symptoms include abdominal pain, constipation, anorexia, joint pain, muscle pain, fatigue, sleep disturbance, headaches, decreased sex drive, difficulty in concentration, short term memory loss, irritability, and depression.

If you’re taking supplements or medications purchased overseas, speak to your doctor to see if a lead level test is recommended.

Case study

Lead toxicity was recently identified in a teenage patient with a history of iron, B12 and folate deficiency who was experiencing chest pains, palpitations, insomnia, abdominal pain, constipation, nausea, headaches, and vomiting.

CBE testing revealed mild microcytic hypochromic red cells with a significantly marked anaemia where the haemoglobin level was 64g/L. The critical haemoglobin warranted a blood film assessment where the morphologist noted striking intensely stained coarse basophilic stippling within the red cells and the nucleated red cells and increasing polychromasia.

The significance of the basophilic inclusions dispersed throughout the mature and immature red cell cytoplasm is characteristic of both disturbed erythropoiesis and erythrocytic maturation. These inclusions are precipitations of fragmented ribosomal ribonucleic acid (RNA) or composed of aggregates of ribosomes and degenerating mitochondria.

Our Morphologists identified the coarsely stained basophilic stippling within the red cells as the hallmark red cell change for the diagnosis of lead toxicity.

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We also investigated:

  • severe iron deficiency – however, the basophilic stippling was too significant and the increasing polychromasia indicated a robust marrow response, inconsistent with depleted iron stores,
  •  thalassaemia/haemoglobinopathy – however, the screening test indicated neither was present.

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A lead level test confirmed extremely elevated levels at 4.82 µmol/L, with the reference range being 0-0.24 µmol/L.

These levels are rarely seen in Australia – the patient confirmed she was taking medication purchased overseas and investigations revealed the medications contained a high lead content.

The patient received two units of red blood cells and commenced treatment for lead toxicity.

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