Lead Poisoning, and Iron Overload
While lead poisoning often is taught as a potential issue in pediatrics and while children are to be screened for lead levels, the condition occurs in adults as well. Historians have found evidence of symptoms in people dating back many centuries, one example being ancient Rome, which is known to have used lead in the aqueducts carrying water. Today, many different industrial products contain lead, including jet engines of aircraft. Those at risk are the people who work with the products. Thus, occupational exposure is a risk factor. People at risk may include battery workers, automobile and aircraft mechanics, welders, glass manufacturers, and plumbers.
A patient with lead poisoning may present with lack of appetite, irritability, and abdominal pain, all of which are classic symptoms. Other classic symptoms include sleep disorders, headaches, constipation, although no symptoms are pathognomonic.In addition to elevated lead levels, analysis of blood of patients with lead poisoning typically reveals dark inclusions in red blood cells, known as basophilic stippling, while the coloring of the RBCs is dimmed or hypchromatic. This same observation also occurs in deficiencies of cobalamin (vitamin B12) and folic acid which lead to megaloblastic anemia (choice B), and in thalassemia.
Treatment of lead poisoning includes removal from the source of lead, which in the case of this worker probably means changing his duties. In cases of lead poisoning due to occupational exposure, it also will lead to investigation of the facility where he works by government officials. In the United States, this means agents from the Occupational Safety and Health Administration (OSHA). Such investigations result when it is suspected that proper exposure and safety regulations are not being observed, and it is appropriate for clinicians to notify such authorities of cases of toxicity due to occupational exposure. Chelation using EDTA or other agents can help in the removal of lead from the body, although it is not certain whether this is effective in removing lead from the brain.
Iron is vital to normal physiological function and deficiencies lead to disease, but too much iron can lead to trouble too. Hemochromatosis a condition on which the body is overloaded with iron, which accumulates in organs. It can occur as an inherited autosomal recessive genetic disorder, which is most common in Caucasians, or it may result from conditions that increase the body's iron stores or absorption, or in cases of excessive iron intake. Premenopausal women are at risk for the condition if they use using contraceptives, which tend to increase the body's iron stores.