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Images of Memorable Cases: Case 81

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

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Case_81-pres1-1.jpg

Peripheral blood film from an anemic 53-year-old geophysicist who complained of fatigue and constipation. The blood film of his asymptomatic wife showed similar changes, but that of his 12-year-old son was normal.

81. Lead poisoning

Basophilic stippling of this patient’s red cells (image below, arrows) suggested lead poisoning. Despite repeated inquiry, however, no source for such poisoning emerged. The plot thickened when blood lead concentrations were substantially elevated in both the man and his wife but normal in their son. Continued sleuthing ultimately unveiled the culprit — cocktail glasses decorated with lead-based paint. The husband and wife drank from these glasses daily, but their son never drank from them. Washing the glasses by machine presumably caused leaching of lead salts. Chelation therapy for the two adults returned their hematologic findings to normal, and the patient became asymptomatic.

Moral: Basophilic stippling of red cells can be the first, best, or only clue to lead poisoning.

Case_81-diag1-1.jpg

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