USMLE (Fach) / Hematology and Oncology (Lektion)
Lead inhibits ferrochelatase and ALA dehydratase → ↓ heme synthesis and ↑ RBC protoporphyrin, ALA. - Also inhibits rRNA degradation → rRNA aggregates (basophilic stippling).
Symptoms:- Lead lines on gingivae (Burton lines) and on metaphyses of long bones on x-ray- Encephalopathy - Abdominal colic - Drops – wrist and foot drop- Children – exposure to old houses with chipped lead paint → mental deterioration- Adults – environmental exposure (eg, batteries, ammunition, construction) → headache, memory loss, demyelination
Lab findings:- Sideroblastic anemia (microcytic)- Basophilic stippling on peripheral smear- Elevated venous lead level and serum zinc protoporphyrin level
Treatment: Dimercaprol and EDTA- Succimer used for chelation in kids
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