Extra ordinary high blood lead levels in Mashhad,Iran: a one-year study in a referral center

Lead is a heavy metal with vast usage in the industry. Lead toxicity affects any organ in the body. It causes various clinical presentations, which leads to diagnostic complexity. Regarding recent increased observation of cases with lead toxicity in our center, we aimed to evaluate the frequencies of lead toxicity in patients referred to Imam-Reza Hospital’s laboratory and find a possible relationship between the blood lead level (BLL) and hematological and biochemical tests.

From 2016 to 2017, the patients referred to Imam-Reza hospital’s laboratory to detect BLL enrolled in the study. Among them, 254 adult cases with BLLs≥10 μg/dl were selected. Complete blood counts and peripheral blood smear were done. Other lab data were extracted from hospital files.

The mean BLL of 1649 participants was 59.11±116.25 μg/dl, ranging from 0 to 1580. Sixty nine percent of them had lead toxicity. Eighty-one percent (n=1341) of patients were males and 18.7% (n=308) were females. In 254 selected cases, the mean BLL was 138.17±189.98 μg/dl. There were significant inverse correlations between BLL and red blood cell counts, hemoglobin, mean cell hemoglobin, total iron-binding capacity, target shape and basophilic stippling, as well as positive correlations between BLL and white blood cell counts, red cell distribution width, neutrophil counts and iron.

Lead toxicity seems to be more frequent than it is expected. Patients with unexplained anemia with increased iron and decreased total iron-binding capacity are better to be evaluated for BLL.