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Should all patients with unexplained anaemia be screened for chronic lead poisoning?

Guy's and St Thomas' Poisons Unit, Medical Toxicology Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK; Medical Toxicology Unit, Guy's and St Thomas' NHS Trust, Avonley Road, SE14 5ER, London, UK indika.gawarammana{at}gstt.nhs.uk;indikagawarammana@yahoo.com

P I Dargan

Guy's and St Thomas' Poisons Unit, Medical Toxicology Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK

S Woodcock

M Sculley

Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK

I M House

D M Wood

A L Jones

Guy's and St Thomas' Poisons Unit, Medical Toxicology Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK

The global prevalence of lead poisoning is declining. However, the prevalence of lead poisoning in patients with either microcytic or normocytic anaemia is unknown. Blood samples from anaemic patients residing in south-east London without an obvious cause for anaemia had their blood lead concentration (BLC) analysed.A batch of 988 samples was analysed for BLC using atomic absorption spectroscopy. Median haemoglobin was 10.3 g/dL (range: 4.2–10.9) in females, 10.6 g/dL (range: 5.2–11.4) in males and 10.7 g/dL (range: 6.7–10.9) in children. Median BLC was 2.63 µg/dL (0.21–24.0 µg/dL; 95th centile 7.54 µg/dL). Fifteen samples (1.5%) had a BLC>10.0 µg/dL, five samples (1%)>15.0 µg/dL and one sample (0.1%)>20.0 µg/L. In the 106 children, median BLC was 2.34 µg/dL (0.5–14.5 µg/dL; 95th centile 6.12 µg/ dL). Only one child (14.5 µg/L) had a BLC>10.0 µg/dL. There was a poor correlation between haemoglobin and BLC (r2=0.08).Routine screening for lead poisoning cannot be justified in all patients with unexplained anaemia, unless there is a history or clinical features to suggest lead toxicity. Additionally, we have shown that in this former high-risk area for lead exposure, there is a low point prevalence of significant lead poisoning, even in an anaemic population.

Key Words: anaemia • epidemiology • lead • poisoning • screening

Human & Experimental Toxicology, Vol. 25, No. 11, 645-649 (2006)
DOI: 10.1177/0960327106074594


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