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The Possibility of Occult Lead Poisoning–Reply

      We thank Dr Brown for drawing attention to an unusual cause of anemia that can affect elderly persons. Although the magnitude of risk from hair dyes is uncertain,
      • Fisher AA
      The safety of Grecian Formula hair dyes containing lead acetate.
      • Gorlick GM
      Toxic beards [letter]?.
      • Searle CE
      • Harnden DG
      Lead in hair-dye preparations [letter].
      environmental exposure to lead is common enough that lead intoxication should routinely be considered in the differential diagnosis of unexplained anemia, especially in patients from outside the United States.
      • Centers for Disease Control and Prevention (CDC)
      Elevated blood lead levels among internationally adopted children—United States, 1998.
      In addition to the paint and toys mentioned by Dr Brown, nonoccupational sources of lead exposure have included ceramic glazes
      • Autenrieth T
      • Schmidt T
      • Habscheid W
      Lead poisoning caused by a Greek ceramic cup [in German].
      (a potential danger for nursing home residents participating in ceramic arts programs
      • Vance MV
      • Curry SC
      • Bradley JM
      • Kunkel DB
      • Gerkin RD
      • Bond GR
      Acute lead poisoning in nursing home and psychiatric patients from the ingestion of lead-based ceramic glazes.
      ), traditional medicines,
      • Kales SN
      • Christophi CA
      • Saper RB
      Hematopoietic toxicity from lead-containing Ayurvedic medications.
      cosmetics (especially kohl-based eyeliner
      • Sprinkle RV
      Leaded eye cosmetics: a cultural cause of elevated lead levels in children.
      ), candy,
      • Gerstenberger SL
      • Savage G
      • Sellers C
      • Zupnik K
      • Gorospe EC
      Lead-contaminated candies in southern Nevada [letter].
      metal lunchboxes,
      • Daluga M
      • Miller K
      Lead in your child's lunch box.
      and several others. Although the peripheral blood smear often reveals basophilic stippling in lead intoxication, this test is neither specific nor highly sensitive, and other assays such as blood lead and erythrocyte zinc protoporphyrin measurements might be necessary to make the diagnosis.
      • Cheson BD
      • Rom WN
      • Webber RC
      Basophilic stippling of red blood cells: a nonspecific finding of multiple etiology.

      REFERENCES

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        Hematopoietic toxicity from lead-containing Ayurvedic medications.
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        J Fam Pract. 1995; 40: 358-362
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        Public Health Rep. 2007; 122: 572
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        Lead in your child's lunch box.
        Clin Pediatr (Phila). 2007; 46: 151-153
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        Basophilic stippling of red blood cells: a nonspecific finding of multiple etiology.
        Am J Ind Med. 1984; 5: 327-334

      Linked Article

      • The Possibility of Occult Lead Poisoning
        Mayo Clinic ProceedingsVol. 83Issue 3
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          To the Editor: In their review of anemia in the elderly, Steensma and Tefferi underestimate the importance of lead poisoning.1 Lead-containing hair dyes, available over-the-counter in most drugstores, can cause anemia in the elderly due to transdermal absorption. This possible chronic toxic effect from absorption of lead is increased if the skin is irritated. The hair dye labels advise that the product should not be applied to irritated skin. However, people who use these products to appear younger by coloring gray hair probably ignore this warning, as well as warnings about frequency of use.
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