Patients with lead poisoning will often show basophilic stippling. Microcytosis and hypochromia may be present, and reticulocyte counts may be elevated. The direct antiglobulin test DAT, direct Coombs test should be negative see chapter on laboratory testing for lead. Haptoglobin is very sensitive but not specific for clinically significant hemolysis, as even small amounts of free hemoglobin can deplete normal levels of serum haptoglobin.
It may also be decreased in liver disease. As haptoglobin is an acute phase reactant, it may be elevated in a number of diseases leading to difficulties in interpretation. LDH is present in all tissues, including red cells, so elevations are consistent with hemolysis but very nonspecific, as any cellular damage may affect levels. As such, there are many other disorders that may cause an elevated LDH.
All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Show More. All these situations can cause lead to be taken into the body where it competes with iron for absorption, which can then lead to iron-deficiency anemia. Now the effects of consuming lead go way beyond anemia, as too much lead can cause learning, hearing and behavioral problems, as well. There you have it. A number of possible causes of anemia.
Whereas on the contrary, Froom et al [ 22 ]. However, other studies reported a variable association [ 23 - 27 ]. Lead causes anemia by impairing heme synthesis and increasing the rate of red blood cell destruction [ 28 ]. On the other hand, it is also possible that iron deficiency, which is a proven cause of anemia, leads to increase in the absorption of lead in the body, resulting in high BLL [ 29 , 30 ].
Although a causal pathway cannot be determined, yet the study findings clearly demonstrate an association between varying severity of anemia and elevated BLL. Fe, Cu and Zn are essential elements for the maintenance of life and health. Pb which is a heavy metal, can be harmful to human health. Therefore, the blood level of these elements in children was determined. Because of the presence of high BLL in drinking water, as reported by the WHO, this study was carried out to reveal the relationship between high blood lead levels, trace elements as well as hematological parameters in children.
In the present study, the level of iron in the anemic group was found to be significantly lower than the control as was expected, similarly Jain et al [ 6 ]. As Fe has an essential role in many biological processes and as deficiency is a World health problem, especially for infants and rapidly growing adolescents. Therefore, it is important to maintain iron concentration within its narrow normal range [ 31 ].
In the present study serum Zn level of the anemic group is insignificantly lower than the control group. There is an antagonism between Zn and Fe absorption from the gastrointestinal tract, as an increase iron concentration in the intestinal lumen may antagonize the uptake of Zn [ 32 ].
A study done by Sebahat et al [ 1 ]. In accordance, although the present study revealed the Cu level to be higher in the anemic more than control group yet, this increase was not statistically significant.
However, Cu has a role in the absorption of iron. The oxidation of ferrous iron into ferric state is carried by ceruloplasmin. This depletion of Cu could impair iron absorption [ 33 ]. In the present study, the serum level of Pb in the anemic group was significantly higher than in the control.
A possible explanation is that Fe deficiency increases absorption of Pb from the intestines. Other studies revealed significant associations between Fe deficiency and high blood lead level [ 30 , 34 ]. Also, blood lead levels were higher in anemic children. This could be due to that decreasing iron level increases lead absorption that in turn affects heme synthesis, thus negatively affecting hematological parameters [ 28 ].
Moreover high BLLs were found to be associated with lower iron and ferritin levels than lower lead levels. This may be that iron absorption occurs predominantly in the duodenum and jejunum. Also, a number of dietary factors influence iron absorption, where ascorbate and citrate increase its uptake.
Lead in particular is a pernicious element to iron metabolism. As it is taken up by the iron absorption machinery instead of iron, and through competitive inhibition. Further more, it interferes with a number of important iron dependent metabolic steps such as heme biosynthesis [ 2 ].
In investigated water samples were considered suitable for drinking according to the EMH [ 35 ]. In Dakahlya-Egypt, lead level in drinking water was higher than the permissible limit according to the WHO. In Egypt, the control of lead is not efficient, so that the level of lead in drinking water in some sporadic areas is still high level [ 37 ]. This was because of a change in water disinfection procedures, which increased the water ability to leach lead from connector pipes between water mains and interior plumbing in old houses [ 38 ].
In developing countries such as India, control of lead pollution is much slower and more sporadic. The present work revealed an association between blood lead level and low serum iron and ferritin levels. This is similar to several studies reporting higher proportions of children with elevated blood lead levels among those with low iron and ferritin levels [ 39 - 41 ].
These results suggest that inadequate iron status may amplify the effect of lead contamination in the environment by increasing absorption and possibly retention of lead in the body [ 39 ]. On the contrary Hershko et al [ 42 ], reported a lack of correlation between iron and blood lead in older children. High BLLs were associated with low blood level of iron and ferritin. Lead level in drinking water was high according to the WHO, and this may be one of the leading causes for elevating BLL in children.
Lead pollution might be controlled and steps should be taken to reduce the prevalence of childhood anemia. AAH contributed to the study design, acquisition of data, analysis and interpretation of data, and drafted the manuscript. MMZ contributed to the study design, acquisition of data.
MAA contributed to study design and interpretation of data, and drafted the manuscript. AAM contributed to the revision of the manuscript. RAS contributed to study design. All authors read and approved the final manuscript. We would like to thank Prof. Gamal H. El-Samra, Prof. We thank Prof. Mona Z. El-Baz, Prof. National Center for Biotechnology Information , U. BMC Res Notes.
Published online May Author information Article notes Copyright and License information Disclaimer. Corresponding author. Amal A Hegazy: moc. Received Nov 14; Accepted May This article has been cited by other articles in PMC. Abstract Background Anemia is a health problem among infants and children. Findings Approximately Background Deficiency of certain trace elements generally causes hypochromic microcytic anemia.
Methods Study population This research was carried out on a total of 60 children from the pediatric clinic in Al-Zhraa Univerisity hospital and a special pediatric clinic in a rural area. Laboratory investigations A venous blood sample was taken from each child and divided into three tubes. Results This study was done on 60 children with ages ranging from 2 to14 years with a mean value of 6.
Table 1 Distribution of individual characteristics in relation to blood lead levels. Open in a separate window. Table 2 Prevalence of anemia in relation to blood lead levels. Table 3 Distribution of hemoglobin level in relation to blood lead levels.
Table 4 Comparison between mean values of different hematological parameters and serum level of ferritin in anemic and control groups.
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