Lead poisoning: Zinc protoporphyrin in blood of children from Santo Amaro da Purificação, Bahia, Brazil

1996 ◽  
Vol 72 (5) ◽  
pp. 295-298 ◽  
Author(s):  
Fernando M. Carvalho ◽  
Annibal M. S. Neto ◽  
Maria F. T. Peres ◽  
Henrique R. Gonçalves ◽  
Gustavo Cardoso Guimarães ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Zinc Protoporphyrin

Screening for Lead Poisoning in an Urban Pediatric Clinic Using Samples Obtained by Fingerstick

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 174-179
Author(s):  
David J. Schonfeld ◽  
Mark R. Cullen ◽  
Petrie M. Rainey ◽  
Anne T. Berg ◽  
David R. Brown ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
False Positive ◽  
Lead Concentration ◽  
Capillary Tube ◽  
Graphite Furnace ◽  
False Positive Rate ◽  
Screening Tests ◽  
Zinc Protoporphyrin ◽  
Pediatric Clinic ◽  
Positive Rate

Objective. To assess the false positive rate of blood (BPb) determinations on sample obtained by fingerstick from children screened in an urban clinic. Method. From a single fingerstick (N = 1573), blood was collected in a capillary tube for determining lead concentration (CPb) by graphite furnace and an additional sample was absorbed onto a filter paper for determining lead concentration (FPb) by atomic absorption spectrophotometry with Delves cup. Zinc protoporphyrin (ZPP) was measured immediately and a confirmatory venous lead (VPb) specimen was obtained at the same visit if the ZPP was ≥35 µg/dL (0.6 µmol/L); children with either a CPb or FPb ≥15 µg/dL (0.7 µmol/L) were later recalled for determining VPb. Results. For the 172 children who had a VPb on the same day as the screening tests, the false positive rates (95% confidence intervals) at a lead threshold of 15 µg/dL (0.7 µmol/L) were: CPb, 13.5% (6.7-20.3); FPb, 19.1% (11.8-26.4). Analyses using all 679 screens with a paired venous specimen (mean delay between screen and venous testing = 30 days) yielded much higher false positive rates (CPb, 31.3%; FPb, 46.0%). Conclusions. Screening for lead poisoning is feasible within an urban pediatric clinic by direct measurement of lead concentration in blood samples obtained by fingerstick. The false positive rate that can be obtained is acceptable given the precision of measuring BPb concentration. Practitioners using a staged screening protocol may incorrectly attribute a higher false positive rate to the screening tests, when much of the error may be due to the temporal variability of BPb resulting from both biologic variability in BPb concentration and intermittent exposures.

The Association between Acute Lead Exposure from Indoor Firing Ranges and Iron Metabolism.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3747-3747
Author(s):  
Drorit Merkel ◽  
Nir Hirshhoren ◽  
Tzippora Shochat ◽  
Asaf Vivante
Keyword(s):  
Young Adults ◽  
Correlation Coefficient ◽  
Lead Poisoning ◽  
Lead Exposure ◽  
Lead Level ◽  
Blood Lead ◽  
Zinc Protoporphyrin ◽  
Short Term ◽  
Iron Depletion ◽  
Post Exposure

Abstract Objective: To assess the impact of short term indoor firing ranges lead exposure and its relationship to iron, ferritin, lead, zinc protoporphyrin and hemoglobin concentration among young adults. Methods: We report of a clinical observation that was carried out in 30 young and healthy soldiers serving in the Israel Defense Forces (IDF) Counter Terrorist Unit (CTU). Blood samples were drawn for Lead (Pb), Zinc Protoporphyrin (ZPP),Iron, Hemoglobin (Hb) and ferritin prior to and after a 6 weeks period of intensive shooting practice in indoor firing ranges. Results: A mean Blood lead level increase (p< 0.0001) with a mean Iron (p<0.0005) and mean ferritin (p<0.0625) decrease simultaneously after 6 weeks period of Lead dusts exposure were demonstrated. We found a trend for inverse correlation between pre-exposure low ferritin levels and post exposure high blood lead levels. Conclusion: We found decreased iron and ferritin levels after short term lead exposure among young adults. This can be explained by competition of iron and lead absorption viatransporters like DMT1 suggesting that lead poisoning can cause iron depletion and that iron depletion can aggravate lead poisoning. This synergistic effect should come to every physicians mind especially when treating patients with a potential risk for each problem separately. Lead (Pb), Zinc Protoporphryn (ZPP), Hemoglobin (Hb), Iron and Ferritin among the CTU soldiers before and after the indoor firing ranges lead exposer variable N Pre-exposure N Post-exposure Difference *P value Pb (mcg/dl) 29 10.3±2.3 30 18.9±3.6 8.8±2.6 0.0001 ZPP(mcg/dl) 29 42±7.5 30 42.9±8.1 0.03±6.5 NS Hb (g/dl) 30 15±0.7 30 14.8±0.9 0.2±0.2 NS MCV (fl) 30 88.7±2.5 30 89±2.7 0.3±0.2 NS Iron (mcg/dl) 29 108.5±43.6 30 77.4±24.4 −30.4±41.2 0.0005 Ferritin (mcg/l) 27 58.1±27.7 16 51±19.9 −6.1±10.7 0.0625 Correlation between Pre-exposure Ferritin levels and Post exposure Lead level.(Person correlation coefficient = −0.28 r=0.14 number of observations = 27) Correlation between Pre-exposure Ferritin levels and Post exposure Lead level.(Person correlation coefficient = −0.28 r=0.14 number of observations = 27)

scholarly journals Lead Toxicity in a Family as a Result of Occupational Exposure

2008 ◽  
Vol 59 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Aryapu Raviraja ◽  
Gaja Babu ◽  
Anita Bijoor ◽  
Geraldine Menezes ◽  
Thuppil Venkatesh
Keyword(s):  
Occupational Exposure ◽  
Liver Function ◽  
Lead Poisoning ◽  
Lead Toxicity ◽  
Blood Lead ◽  
Blood Lead Levels ◽  
Zinc Protoporphyrin ◽  
Function Tests ◽  
The Family ◽  
Lead Levels

Lead Toxicity in a Family as a Result of Occupational ExposureThis article describes an entire family manufacturing lead acid batteries who all suffered from lead poisoning. The family of five lived in a house, part of which had been used for various stages of battery production for 14 years. Open space was used for drying batteries. They all drank water from a well located on the premises. Evaluation of biomarkers of lead exposure and/or effect revealed alarming blood lead levels [(3.92±0.94) μmol L-1], 50 % reduction in the activity of δ-aminolevulinic acid dehydratase [(24.67±5.12) U L-1] and an increase in zinc protoporphyrin [(1228±480) μg L-1]. Liver function tests showed an increase in serum alkaline phosphatase [(170.41±41.82) U L-1]. All other liver function test parameters were normal. Renal function tests showed an increase in serum uric acid [(515.81±86.29) μmol L-1] while urea and creatinine were normal. Serum calcium was low [(1.90±0.42) mmol L-1in women and (2.09±0.12) mmol L-1in men], while blood pressure was high in the head of the family and his wife and normal in children. Lead concentration in well water was estimated to 180 μg L-1. The family was referred to the National Referral Centre for Lead Poisoning in India, were they were received treatment and were informed about the hazards of lead poisoning. A follow up three months later showed a slight decrease in blood lead levels and a significant increase in haemoglobin. These findings can be attributed to behavioural changes adopted by the family, even though they continued producing lead batteries.

Efficacy of d-Penicillamine in Reducing Lead Concentrations in Children: A Prospective, Uncontrolled Study

2000 ◽  
Vol 16 (3) ◽  
pp. 98-101
Author(s):  
Matitiahu Lifshitz ◽  
Jacov Levy
Keyword(s):  
Young Children ◽  
Lead Poisoning ◽  
Blood Lead ◽  
Zinc Protoporphyrin ◽  
Blood Concentrations ◽  
Uncontrolled Study ◽  
Limited Effectiveness ◽  
The Mean ◽  
Blood Zinc ◽  
Penicillamine Therapy

Objective: To evaluate the efficacy of oral d-penicillamine therapy in children with high blood lead concentrations. Design: A prospective, uncontrolled study. Methods and Patients: Seven children (2–16 y old; mean 8.7) with elevated blood lead concentrations but no symptoms of lead poisoning were treated with oral d-penicillamine. Lead-contaminated homemade flour as found to be the source of poisoning. Mean ± SD blood lead concentrations prior to therapy were 60.3 ± 12.9 μg/dL (range 47.8–83). Mean blood zinc protoporphyrin (ZPP) was 337.86 ± 58.55 μmol/mol hemoglobin (Hb) (range 247–394). Results: Ninety days of treatment with d-penicillamine lowered the mean blood lead concentration by 31.7% to a mean of 40.7 ± 8.6 μg/dL (range 30–53) and lowered mean ZPP blood concentrations by 40% to a mean of 201.14 ± 14 μmol/mol Hb (range 150–278). Three patients with blood lead concentrations >45 μg/mL at the end of this therapy were subsequently treated with succimer, an alternative oral chelator; the blood lead concentrations were further reduced to <45 μg/mL. Conclusions: d-Penicillamine therapy significantly reduced blood lead concentrations but did not achieve acceptable lead and ZPP concentrations for young children. Therefore, we conclude that 90 days of d-penicillamine treatment is of limited effectiveness in young children who have high blood lead concentrations and also show symptoms of lead poisoning.

Interaction of Iron Deficiency and Lead and the Hematologic Findings in Children With Severe Lead Poisoning

PEDIATRICS ◽  
1988 ◽  
Vol 81 (2) ◽  
pp. 247-254
Author(s):  
Margaret Clark ◽  
Joyce Royal ◽  
Ruth Seeler
Keyword(s):  
Iron Deficiency ◽  
Lead Poisoning ◽  
Iron Status ◽  
Lead Level ◽  
Transferrin Saturation ◽  
Hemoglobin Concentration ◽  
Microcytic Anemia ◽  
Cook County ◽  
Cook County Hospital ◽  
Zinc Protoporphyrin

Microcytic anemia, long considered an effect of lead poisoning, may in fact result from coexisting iron deficiency. In this study, how RBC size, hemoglobin, and zinc protoporphyrin vary as a function of iron status in a group of children with high lead levels was examined. Charts of all children (N = 51) admitted to Cook County Hospital for treatment of lead poisoning in 1981 to 1983 were reviewed for data on age, blood lead level, hemoglobin concentration, MCV, transferrin saturation and zinc protoporphyrin level. The mean lead level was 86 µg/dL and the range was 63 to 190 µg/dL. Children with transferrin saturation values less than 7% had a mean MCV of 56 pµL, hemoglobin of 8.9 g/dL, and zinc protoporphyrin of 693 µg/dL; for those with saturations of 7% to 16%, the values were 61 µL, 10.1 g/dL, and 581 µg/dL, respectively; the children with saturations greater than 16% had normal mean MCVs and hemoglobin concentrations (74 µL and 11.4 g/dL) and a mean zinc protoporphyrin value of 240 µg/dL (P &lt; .0005). Multiple linear regression was used to correct for effect of age, and transferrin saturation remained the most important predictor of MCV, hemoglobin, and zinc protoporphyrin levels; the addition of lead did not improve the models. Results of this study suggest that iron deficiency is strongly associated with some of the observed toxicities of lead. Also, lead poisoning can exist without producing microcytosis or anemia, and zinc protoporphyrin concentration may not be a sensitive indicator of lead level in the absence of iron deficiency.

Lead poisoning from Asian traditional remedies in the West Midlands - report of a series of five cases

1995 ◽  
Vol 14 (1) ◽  
pp. 24-28 ◽  
Author(s):  
G.R. Bayly ◽  
R.A. Braithwaite ◽  
T.M.T. Sheehan ◽  
N.H. Dyer ◽  
C. Grimley ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Blood Lead ◽  
Zinc Protoporphyrin ◽  
The West ◽  
Traditional Remedies ◽  
Lead And Zinc ◽  
West Midlands ◽  
Weight One ◽  
Lead Isotopic Ratios ◽  
Made In

1 Traditional remedies are an unusual, but recognised cause of lead poisoning. Only two cases have previously been reported in this country. 2 We report a series of five cases of lead poisoning due to traditional remedies in the West Midlands. All devel oped typical clinical features. 3 Blood lead and zinc protoporphyrin (ZPP) concentra tions were elevated 2-10 times the upper limit of nor mal. The remedies contained up to 60% lead by weight. One also contained traces of mercury, another arsenic, and a third aluminium and tin. 4 Confirmation of the medicines as the cause of the poi soning was made in one patient by measurement of lead isotopic ratios. 5 The present morbidity from traditional remedies may be far greater than is realised, and will continue until such time as the supply of harmful preparations can be effec tively limited. There needs to be increased awareness of their dangers amongst doctors and the communities at risk. This will best be achieved by appropriately targeted education.

Empirically determined lead-poisoning screening cutoff for the Protofluor-Z hematofluorometer.

1989 ◽  
Vol 35 (10) ◽  
pp. 2104-2107 ◽  
Author(s):  
N V Stanton ◽  
E W Gunter ◽  
P J Parsons ◽  
P H Field
Keyword(s):  
Lead Poisoning ◽  
Extraction Procedure ◽  
Molar Ratio ◽  
Zinc Protoporphyrin ◽  
Acid Extraction ◽  
A Value ◽  
Acetic Acid Extraction ◽  
Blood Specimens ◽  
Lead Poisoning Prevention ◽  
Poisoning Prevention

Abstract A recently introduced hematofluorometer, the "Protofluor-Z" (Helena Laboratories, Beaumont, TX), has several novel features, most notably reporting units expressed as the molar ratio of zinc protoporphyrin (ZPP) to heme, i.e., micromoles of ZPP per mole of heme. We analyzed human blood specimens on the Protofluor-Z and by an ethyl acetate/acetic acid extraction procedure. Data from three laboratories were pooled and used to provide a comparison of the two methods. Results indicate that, with the Protofluor-Z, a value of 70 mumol of ZPP per mole of heme is approximately equivalent to the recommended screening cutoff of 35 micrograms of erythrocyte protoporphyrin per 100 mL of whole blood used in programs for pediatric lead-poisoning prevention. This empirically determined value is slightly lower than either that recommended by the manufacturer or a theoretical cutoff value that was determined mathematically.

scholarly journals Pitfalls in Erythrocyte Protoporphyrin Measurement for Diagnosis and Monitoring of Protoporphyrias

2015 ◽  
Vol 61 (12) ◽  
pp. 1453-1456 ◽  
Author(s):  
Eric W Gou ◽  
Manisha Balwani ◽  
D Montgomery Bissell ◽  
Joseph R Bloomer ◽  
Herbert L Bonkovsky ◽  
...  
Keyword(s):  
Lead Poisoning ◽  
Reference Interval ◽  
Laboratory Diagnosis ◽  
Reference Intervals ◽  
Zinc Protoporphyrin ◽  
Similar Increase ◽  
Erythropoietic Protoporphyria ◽  
Metal Free ◽  
Erythrocyte Protoporphyrin

Abstract BACKGROUND Laboratory diagnosis of erythropoietic protoporphyria (EPP) requires a marked increase in total erythrocyte protoporphyrin (300–5000 μg/dL erythrocytes, reference interval &lt;80 μg/dL) and a predominance (85%–100%) of metal-free protoporphyrin [normal, mostly zinc protoporphyrin (reference intervals for the zinc protoporphyrin proportion have not been established)]; plasma porphyrins are not always increased. X-linked protoporphyria (XLP) causes a similar increase in total erythrocyte protoporphyrin with a lower fraction of metal-free protoporphyrin (50%–85% of the total). CONTENT In studying more than 180 patients with EPP and XLP, the Porphyrias Consortium found that erythrocyte protoporphyrin concentrations for some patients were much higher (4.3- to 46.7-fold) than indicated by previous reports provided by these patients. The discrepant earlier reports, which sometimes caused the diagnosis to be missed initially, were from laboratories that measure protoporphyrin only by hematofluorometry, which is intended primarily to screen for lead poisoning. However, the instrument can calculate results on the basis of assumed hematocrits and reports results as “free” and “zinc” protoporphyrin (with different reference intervals), implying separate measurements of metal-free and zinc protoporphyrin. Such misleading reports impair diagnosis and monitoring of patients with protoporphyria. SUMMARY We suggest that laboratories should prioritize testing for EPP and XLP, because accurate measurement of erythrocyte total and metal-free protoporphyrin is essential for diagnosis and monitoring of these conditions, but less important for other disorders. Terms and abbreviations used in reporting erythrocyte protoporphyrin results should be accurately defined.

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