Friday, 24 September 2010

MRCP revision battle 19.8: Lead poisoning

Lead poisoning is a good topic as it has 2 nice distinctive features (blue lines on nail growth margins and basophillic stippling of red blood cells.)

A more comprehensive list of lead poisoning features is:
  • abdominal pain
  • constipation
  • peripheral neuropathy
  • fatigue

Blue lines on the growth margin of nails affect 20% adults with lead poisoning but are rare in children.

Investigations should show:
  • microcytic anaemia
  • basophillic stippling of red blood cells
  • raised aminolevulinic acid levels (a haem precursor)

 The image below shows basophillic stippling of red blood cells (right and left arrows)

Treatment is by chelation with either EDTA, d-penicillamine or dimercaprol.

Thats today wrapped up; questions on yesterday's battles can be found here