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,
1
, 2
, 3
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.4
In addition to the paint and toys mentioned by Dr Brown, nonoccupational sources of lead exposure have included ceramic glazes5
(a potential danger for nursing home residents participating in ceramic arts programs6
), traditional medicines,7
cosmetics (especially kohl-based eyeliner8
), candy,9
metal lunchboxes,10
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.11
REFERENCES
- The safety of Grecian Formula hair dyes containing lead acetate.Cutis. 1997; 60: 122
- Toxic beards [letter]?.Pediatrics. 1999; 103: 1313
- Lead in hair-dye preparations [letter].Lancet. 1979; 2: 1070
- Elevated blood lead levels among internationally adopted children—United States, 1998.MMWR Morb Mortal Wkly Rep. 2000; 49: 97-100
- Lead poisoning caused by a Greek ceramic cup [in German].Dtsch Med Wochenschr. 1998; 123: 353-358
- Acute lead poisoning in nursing home and psychiatric patients from the ingestion of lead-based ceramic glazes.Arch Intern Med. 1990; 150: 2085-2092
- Hematopoietic toxicity from lead-containing Ayurvedic medications.Med Sci Monit. 2007; 13: CR295-CR298
- Leaded eye cosmetics: a cultural cause of elevated lead levels in children.J Fam Pract. 1995; 40: 358-362
- Lead-contaminated candies in southern Nevada [letter].Public Health Rep. 2007; 122: 572
- Lead in your child's lunch box.Clin Pediatr (Phila). 2007; 46: 151-153
- Basophilic stippling of red blood cells: a nonspecific finding of multiple etiology.Am J Ind Med. 1984; 5: 327-334
Article Info
Identification
Copyright
© 2008 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The Possibility of Occult Lead PoisoningMayo Clinic ProceedingsVol. 83Issue 3
- PreviewTo 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.
- Full-Text
- Preview
