A 25 year old woman presents with recurrent abdominal pain and anemia. Peripheral blood smear shows basophilic stippling of the red blood cells. What is the most likely diagnosis -
Ans. is 'd' i.e., Lead poisoning The diagnosis can easily be made from the presence of Basophilic stippling. None of the causes other than lead poisoning are mentioned the question.Causes of basophilic stippling.Lead poisoningMegaloblastic anemiaThalassemiasSideroblastic anemiaAlcoholismPyrimidine-5-nucleotidase deficiency Features of lead poisoningAcute lead poisoning (rare)The principal manifestations of acute lead poisoning are gastrointestinal and central nervous system disturbances.Higher blood levels are usually associated with impaired neurotransmission and neuronal cell death, at still higher level lead encephalopathy and death may occur.Chronic lead poisoningLead poisoning is nearly always of the chronic typeSign and symptoms of chronic poisoning.Facial pallor - earliest and most consistent sign (due to vasospasm)Hypochromic anemia with punctate basophiliaLead line - Stippled bluish black lines on the gums at the junction with the teeth (not on the teeth)Colic and constipation - It is a late manifestation but constitutes an acute symptom of chronic plumbism.Paralysis - Late manifestation, usually wrist drop or foot drop occurs (motor delays on nerve conduction)Encephalopathy - Lead encephalopathy in some form or the other is said to be present in every case.Renovascular - - Elevated protoporphyrin levelT/T * If astutely toxic- Hospitalization and I.V. or* In highlyI.m.chelation with edentate calcium disodium (CaEDTA). Dimercaprol is also required to prevent encephalopathy.- Chelation with oral DMSAexposed(succimer with symptoms)Also know, Exposure to lead mainly occurs through auto batteries, lead crystal ceramics, fishing weight etc.
Coeliac disease
Hookworm infestation
Sickle cell disease
Lead poisoning
Anemia and RBC Disorders